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General NPI Number Information
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NPI Number | 1275849192
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Entity Type | Organization
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Legal Business Name | UM AUTISM SPECTRUM ASSESSMENT CLINIC
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 5665 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33146-2510
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Country | US
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Telephone | 305-284-2350
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Fax |
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Provider Business Mailing Address
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Address Line | 5665 PONCE DE LEON BLVD
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City | CORAL GABLES
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State | FL
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Zip | 33146-2510
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/CLINICAL SUPERVISOR
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Name | MELISSA HALE
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Credential | PH.D.
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Telephone | 305-284-2350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7272
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License Number State | FL
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