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General NPI Number Information
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NPI Number | 1437423365
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Entity Type | Organization
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Legal Business Name | GRAND PSYCHOLOGY CORP.
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 9150 SW 87TH AVE SUITE 109
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City | MIAMI
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State | FL
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Zip | 33176-2319
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Country | US
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Telephone | 305-596-4663
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Fax | 305-596-6947
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Provider Business Mailing Address
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Address Line | 9150 SW 87TH AVE SUITE 109
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City | MIAMI
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State | FL
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Zip | 33176-2319
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Country | US
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Telephone | 305-596-4663
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Fax | 305-596-6947
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. CRISTINA GRAND
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Credential | PSY D, ABPP
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Telephone | 305-596-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PY5822
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License Number State | FL
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