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General NPI Number Information
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NPI Number | 1588178180
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Entity Type | Organization
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Legal Business Name | ACADEMIA BEHAVIORAL CONSULTANTS, LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 7485 FAIRWAY DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-7822
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Country | US
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Telephone | 786-991-7085
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Fax |
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Provider Business Mailing Address
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Address Line | 6923 W 25TH CT
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City | HIALEAH
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State | FL
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Zip | 33016-5463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RODRIGO J. LOZANO
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Credential | LCSW
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Telephone | 786-991-7085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | SW13005
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License Number State | FL
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