Provider Demographics
NPI:1982725479
Name:PSYCHOLOGICAL CENTER FOR CHILDREN AND ADOLESCENTS
Entity Type:Organization
Organization Name:PSYCHOLOGICAL CENTER FOR CHILDREN AND ADOLESCENTS
Other - Org Name:PECCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZARET
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:305-446-7673
Mailing Address - Street 1:2519 GALIANO ST
Mailing Address - Street 2:SUITE 712
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6132
Mailing Address - Country:US
Mailing Address - Phone:305-446-7673
Mailing Address - Fax:305-446-1440
Practice Address - Street 1:2519 GALIANO ST
Practice Address - Street 2:SUITE 712
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6132
Practice Address - Country:US
Practice Address - Phone:305-446-7673
Practice Address - Fax:305-446-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty