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General NPI Number Information
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NPI Number | 1447436340
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Entity Type | Organization
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Legal Business Name | DMHG PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 03/06/2013
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Provider Practice Location Address
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Address Line | 4963 SW 128TH TER
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City | MIRAMAR
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State | FL
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Zip | 33027-5508
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Country | US
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Telephone | 305-877-7051
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Fax |
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Provider Business Mailing Address
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Address Line | 4963 SW 128TH TER
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City | MIRAMAR
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State | FL
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Zip | 33027-5508
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Country | US
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Telephone | 305-877-7051
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Fax |
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Authorized Official
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Title or Position | MGMR/OWNER
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Name | DR. MARY DENISE DECRUISE
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Credential | PSY.D
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Telephone | 305-877-7051
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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 | PY 7636
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License Number State | FL
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