Healthcare Provider Details

I. General information

NPI: 1164805305
Provider Name (Legal Business Name): FLORIDA INTERNATIONAL UNIVERSITY BOARD OF TRUSTEES CENTER FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 SW 8TH ST AHC 1 ROOM 140
MIAMI FL
33199-2516
US

IV. Provider business mailing address

11200 SW 8TH ST AHC 1 ROOM 140
MIAMI FL
33199-2516
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-0477
  • Fax: 305-348-3646
Mailing address:
  • Phone: 305-348-0477
  • Fax: 305-348-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM PELHAM
Title or Position: DIRECTOR
Credential: PHD
Phone: 305-348-3002