Healthcare Provider Details

I. General information

NPI: 1194023069
Provider Name (Legal Business Name): MILESTONES CENTER FOR CHILD DEVELOPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ISLAND AVE APT 611
MIAMI BEACH FL
33139-1357
US

IV. Provider business mailing address

9 ISLAND AVE APT 611
MIAMI BEACH FL
33139-1357
US

V. Phone/Fax

Practice location:
  • Phone: 305-531-1591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: HILLARY M PEDERSEN
Title or Position: MANAGER
Credential:
Phone: 305-531-1591