Healthcare Provider Details

I. General information

NPI: 1578108403
Provider Name (Legal Business Name): DESIGUAL THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 PONCE DE LEON BLVD STE 307
CORAL GABLES FL
33134-2070
US

IV. Provider business mailing address

717 PONCE DE LEON BLVD STE 307
CORAL GABLES FL
33134-2070
US

V. Phone/Fax

Practice location:
  • Phone: 305-952-3247
  • Fax: 305-952-3248
Mailing address:
  • Phone: 305-952-3247
  • Fax: 305-952-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: INDIRA A ALVAREZ SAENZ
Title or Position: PRESIDENT
Credential: MCSW, ICSW, CBHCMS
Phone: 786-612-4461