Healthcare Provider Details

I. General information

NPI: 1912131855
Provider Name (Legal Business Name): CENTER FOR SELF EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CORAL WAY STE 402
MIAMI FL
33145-3053
US

IV. Provider business mailing address

3400 CORAL WAY STE 402
MIAMI FL
33145-3053
US

V. Phone/Fax

Practice location:
  • Phone: 305-567-1155
  • Fax:
Mailing address:
  • Phone: 305-567-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPY3408
License Number StateFL

VIII. Authorized Official

Name: CIBELES HERNANDEZ
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 305-567-1155