Healthcare Provider Details

I. General information

NPI: 1720309438
Provider Name (Legal Business Name): HEALTH PSYCHOLOGY GROUP OF SOUTH FLORIDA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SW 74TH ST SUITE 201
SOUTH MIAMI FL
33143-5165
US

IV. Provider business mailing address

5901 SW 74TH ST SUITE 201
SOUTH MIAMI FL
33143-5165
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-8595
  • Fax: 305-661-2944
Mailing address:
  • Phone: 305-300-8595
  • Fax: 305-661-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY7799
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7799
License Number StateFL

VIII. Authorized Official

Name: LINNETTE CASTILLO
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 305-300-8594