Healthcare Provider Details
I. General information
NPI: 1033902929
Provider Name (Legal Business Name): TIKVAH HEALING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2332 GALIANO ST FL 2
CORAL GABLES FL
33134-5402
US
IV. Provider business mailing address
5612 CARRARA DR
AVE MARIA FL
34142-5248
US
V. Phone/Fax
- Phone: 305-204-1665
- Fax:
- Phone: 305-742-1642
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 106H00000X |
| Taxonomy | Marriage & Family Therapist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YM0800X |
| Taxonomy | Mental Health Counselor |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
TIJUANA
TOLEDO
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LCSW
Phone: 305-204-1665