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General NPI Number Information
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NPI Number | 1316167919
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Entity Type | Organization
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Legal Business Name | PSYCHOSOMA, INC.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8766 SW 8TH ST
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City | MIAMI
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State | FL
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Zip | 33174-3201
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Country | US
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Telephone | 305-221-5366
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Fax | 305-667-9496
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Provider Business Mailing Address
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Address Line | 6750 SW 104TH ST
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City | MIAMI
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State | FL
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Zip | 33156-3252
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Country | US
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Telephone | 305-221-5366
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Fax | 305-667-9496
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Authorized Official
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Title or Position | OWNER PRESIDENT DIRECTOR
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Name | MR. LUIS R. MADERAL
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Credential | M.A., M.DIV.
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Telephone | 305-221-5366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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