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General NPI Number Information
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NPI Number | 1215254107
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Entity Type | Organization
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Legal Business Name | PSYCH ALTERNATIVE INC
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Dates
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Enumeration Date | 04/30/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 15635 SW 16TH CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-2347
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Country | US
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Telephone | 786-337-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 15635 SW 16TH CT
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-2347
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Country | US
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Telephone | 786-337-0355
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MISS ROXANA ACKERMAN
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Credential | LCSW
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Telephone | 786-337-0355
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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 | SW7826
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License Number State | FL
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