Healthcare Provider Details

I. General information

NPI: 1821603101
Provider Name (Legal Business Name): PIVOTAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2020
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3081 SALZEDO ST STE 202
CORAL GABLES FL
33134-6725
US

IV. Provider business mailing address

5810 SW 14TH ST
WEST MIAMI FL
33144-5712
US

V. Phone/Fax

Practice location:
  • Phone: 305-707-1600
  • Fax:
Mailing address:
  • Phone: 305-878-6913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMERICA CONDE
Title or Position: CEO/EXECUTIVE CLINICAL DIRECTOR
Credential: M.S., BCBA
Phone: 305-707-1600