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General NPI Number Information
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NPI Number | 1366574766
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Entity Type | Organization
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Legal Business Name | BERTHA ABESS CHILDREN'S CENTER, INS.
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5801 BISCAYNE BLVD
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City | MIAMI
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State | FL
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Zip | 33137-2638
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Country | US
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Telephone | 305-756-7116
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Fax |
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Provider Business Mailing Address
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Address Line | 15423 SW 115TH ST
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City | MIAMI
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State | FL
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Zip | 33196-6307
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Country | US
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Telephone | 305-323-7113
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Fax | 305-386-5772
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Authorized Official
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Title or Position | CLINICAL SUPERVISOR
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Name | DR. LINDA MARTINEZ
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Credential | PSY.D.
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Telephone | 305-756-7116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 6883
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License Number State | FL
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