=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336364280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE ANN FADIL PSY.D., LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 10/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 S ROYAL POINCIANA BLVD SUITE 300
-----------------------------------------------------
City | MIAMI SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33166-6600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-371-8300
-----------------------------------------------------
Fax | 305-371-1376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 NW 108TH TER
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33026-4021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-905-2265
-----------------------------------------------------
Fax | 954-432-0345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH4708
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------