Healthcare Provider Details

I. General information

NPI: 1114676871
Provider Name (Legal Business Name): S & C PSYCHIATRIC SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20760 NE 4TH CT APT 106
MIAMI FL
33179-1884
US

IV. Provider business mailing address

PO BOX 849045
HOLLYWOOD FL
33084-1045
US

V. Phone/Fax

Practice location:
  • Phone: 305-331-8695
  • Fax:
Mailing address:
  • Phone: 305-331-8695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. YVES GUALBERT DEHAUT
Title or Position: PMHNP
Credential: NP
Phone: 305-331-8695