Healthcare Provider Details

I. General information

NPI: 1932476934
Provider Name (Legal Business Name): INTERNATIONAL CENTER FOR HUMAN RELATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9995 SW 72ND ST STE 213
MIAMI FL
33173-4662
US

IV. Provider business mailing address

9995 SW 72ND ST STE 213
MIAMI FL
33173-4662
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-0045
  • Fax:
Mailing address:
  • Phone: 305-275-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS251
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH124
License Number StateFL

VIII. Authorized Official

Name: DR. LOURDES HERRERA
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 305-275-0045