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General NPI Number Information
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NPI Number | 1003228032
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Entity Type | Organization
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Legal Business Name | DEBORAH M. THEVENIN, PH.D., LLC
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Dates
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Enumeration Date | 05/26/2014
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Last Update Date | 05/26/2014
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Provider Practice Location Address
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Address Line | 7685 SW 104TH ST SUITE 100
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City | MIAMI
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State | FL
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Zip | 33156-3161
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Country | US
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Telephone | 305-666-8000
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Fax | 305-666-4311
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Provider Business Mailing Address
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Address Line | 1500 BAY RD UNIT 716 SOUTH
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3252
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Country | US
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Telephone | 305-495-7603
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Fax | 305-666-4311
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DEBORAH MORRISON THEVENIN
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Credential | PH.D.
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Telephone | 305-495-7603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY4442
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License Number State | FL
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