Healthcare Provider Details

I. General information

NPI: 1801778105
Provider Name (Legal Business Name): SHALOM PSYCHOTHERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7392 NW 35TH TER STE 207-208
MIAMI FL
33122-1271
US

IV. Provider business mailing address

7392 NW 35TH TER STE 207-208
MIAMI FL
33122-1271
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-2329
  • Fax: 786-353-2357
Mailing address:
  • Phone: 786-353-2329
  • Fax: 786-353-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: AMANDA FERNANDEZ RICHARDSON
Title or Position: CEO
Credential:
Phone: 786-353-2329