=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043266331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED PSYCHOLOGICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6262 BIRD RD STE 2F
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-4882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-387-7850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6262 BIRD RD STE 2F
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-4882
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-387-7850
-----------------------------------------------------
Fax | 305-386-0827
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | DR. MERCEDES LLENIN
-----------------------------------------------------
Credential | PH.D
-----------------------------------------------------
Telephone | 305-387-7850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY6075
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------