Healthcare Provider Details

I. General information

NPI: 1154524510
Provider Name (Legal Business Name): LIANNE ACOSTA- GINART PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8020 SW 24TH ST
MIAMI FL
33155-1225
US

IV. Provider business mailing address

PO BOX 441051
MIAMI FL
33144-1051
US

V. Phone/Fax

Practice location:
  • Phone: 786-942-6709
  • Fax:
Mailing address:
  • Phone: 786-942-6709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: