Healthcare Provider Details

I. General information

NPI: 1902528599
Provider Name (Legal Business Name): MENTAE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 MAIN ST APT 1304
MIAMI LAKES FL
33014-2288
US

IV. Provider business mailing address

6600 MAIN ST APT 1304
MIAMI LAKES FL
33014-2288
US

V. Phone/Fax

Practice location:
  • Phone: 786-515-4519
  • Fax:
Mailing address:
  • Phone: 786-515-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA M MOLES
Title or Position: OWNER
Credential: PSY.D.
Phone: 305-557-6755