Provider Demographics
NPI:1881137511
Name:KEDEM, ARI
Entity type:Individual
Prefix:
First Name:ARI
Middle Name:
Last Name:KEDEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 ASTURIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4731
Mailing Address - Country:US
Mailing Address - Phone:305-949-9001
Mailing Address - Fax:305-949-9038
Practice Address - Street 1:1047 ASTURIA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4731
Practice Address - Country:US
Practice Address - Phone:305-949-9001
Practice Address - Fax:305-949-9038
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1365029819201102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1365029819201OtherDEPARTMENT OF CHILDREN AND FAMILIES