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General NPI Number Information
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NPI Number | 1598024325
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL NETWORK
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 250 CATALONIA AVE SUITE 807
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City | CORAL GABLES
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State | FL
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Zip | 33134-6735
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Country | US
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Telephone | 305-648-0604
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Fax |
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Provider Business Mailing Address
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Address Line | 250 CATALONIA AVE SUITE 807
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City | CORAL GABLES
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State | FL
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Zip | 33134-6735
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Country | US
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Telephone | 305-648-0604
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOTHERAPIST
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Name | DR. MARIA PILAR GONDRA
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Credential | PSYD
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Telephone | 305-648-0604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH4296
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License Number State | FL
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