Healthcare Provider Details

I. General information

NPI: 1861328783
Provider Name (Legal Business Name): EMBODY HEALTH PSYCHOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 MYSTIC POINTE DR STE 115
AVENTURA FL
33180-2554
US

IV. Provider business mailing address

3580 MYSTIC POINTE DR STE 115
AVENTURA FL
33180-2554
US

V. Phone/Fax

Practice location:
  • Phone: 305-482-3808
  • Fax:
Mailing address:
  • Phone: 305-482-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIAH ALISE MELISSA STREETER
Title or Position: OWNER/CEO
Credential: PSYD
Phone: 305-482-3808