Healthcare Provider Details

I. General information

NPI: 1497029607
Provider Name (Legal Business Name): EDWARD SUAREZ JR. PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE FL 3
MIAMI FL
33136-1409
US

IV. Provider business mailing address

1695 NW 9TH AVE FL 3
MIAMI FL
33136-1409
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-7000
  • Fax: 305-355-7054
Mailing address:
  • Phone: 305-355-7000
  • Fax: 305-355-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 14509
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY10808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: