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General NPI Number Information
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NPI Number | 1184823908
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Entity Type | Organization
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Legal Business Name | PSYCHAWARENESS, INC.
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 633 NE 167TH ST STE 522
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2443
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Country | US
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Telephone | 305-655-1108
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Fax | 305-655-1139
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Provider Business Mailing Address
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Address Line | 633 NE 167TH ST STE 522
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-2443
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Country | US
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Telephone | 305-655-1108
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Fax | 305-655-1139
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Authorized Official
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Title or Position | CEO
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Name | DR. CORNELIA WENZE
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Credential | ED.D.
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Telephone | 305-655-1108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH 7527
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License Number State | FL
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