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General NPI Number Information
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NPI Number | 1548529712
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Entity Type | Organization
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Legal Business Name | ESSS
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 140 W FLAGLER ST SUITE 1001
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City | MIAMI
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State | FL
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Zip | 33130-1519
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Country | US
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Telephone | 305-375-3293
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Fax | 305-375-4672
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Provider Business Mailing Address
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Address Line | 140 W FLAGLER ST SUITE 1001
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City | MIAMI
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State | FL
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Zip | 33130-1519
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Country | US
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Telephone | 305-375-3293
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Fax | 305-375-4672
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RAYMOND WHITE
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Credential | LCSW
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Telephone | 305-375-3293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1113AD057331
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License Number State | FL
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