Healthcare Provider Details

I. General information

NPI: 1699048538
Provider Name (Legal Business Name): PEDIATRIC & ADULT COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17071 W DIXIE HWY STE 103
NORTH MIAMI BEACH FL
33160-3773
US

IV. Provider business mailing address

1042 NW 159TH AVE
PEMBROKE PINES FL
33028-1609
US

V. Phone/Fax

Practice location:
  • Phone: 305-804-7843
  • Fax: 786-664-3379
Mailing address:
  • Phone: 305-804-7843
  • Fax: 786-664-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6842
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT2219
License Number StateFL

VIII. Authorized Official

Name: ARTURO ALESSIO CID
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 305-804-7843