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General NPI Number Information
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NPI Number | 1043752389
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Entity Type | Organization
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Legal Business Name | GATEWELL THERAPY CENTER
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 4601 PONCE DE LEON BLVD SUITE 260
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City | CORAL GABLES
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State | FL
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Zip | 33146-2111
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Country | US
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Telephone | 305-846-9370
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Fax |
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Provider Business Mailing Address
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Address Line | 4601 PONCE DE LEON BLVD SUITE 260
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City | CORAL GABLES
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State | FL
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Zip | 33146-2111
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Country | US
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Telephone | 305-846-9370
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | STACEY ROSENFELD
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Credential | PHD
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Telephone | 305-846-9370
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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 | PY 9153
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License Number State | FL
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