Healthcare Provider Details

I. General information

NPI: 1376846295
Provider Name (Legal Business Name): DEBORAH MORRISON THEVENIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 SW 104TH ST SUITE 100
MIAMI FL
33156-3161
US

IV. Provider business mailing address

1500 BAY RD UNIT 716 SOUTH
MIAMI BEACH FL
33139-3252
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-8000
  • Fax:
Mailing address:
  • Phone: 305-495-7603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4442
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY4442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: