Healthcare Provider Details

I. General information

NPI: 1013359090
Provider Name (Legal Business Name): SYNERGY CLINICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 NE 185TH ST SUITE 305
AVENTURA FL
33180-2876
US

IV. Provider business mailing address

1250 LINCOLN RD #301
MIAMI BEACH FL
33139-2267
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-5733
  • Fax: 305-933-5233
Mailing address:
  • Phone: 305-467-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS MIRICAL P. SADDLER
Title or Position: PRESIDENT
Credential: LMHC
Phone: 305-467-4531