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General NPI Number Information
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NPI Number | 1063680643
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Entity Type | Organization
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Legal Business Name | ALLIANCE PSYCHOLOGICAL, INC.
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 407 LINCOLN RD STE 6K
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3023
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Country | US
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Telephone | 305-672-1104
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Fax |
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Provider Business Mailing Address
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Address Line | 407 LINCOLN RD STE 6K
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City | MIAMI BEACH
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State | FL
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Zip | 33139-3023
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Country | US
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Telephone | 305-672-1104
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KENNETH CHRISTIANSEN
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Credential | PSY.D.
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Telephone | 305-672-1104
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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 | PY5813
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License Number State | FL
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