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General NPI Number Information
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NPI Number | 1598112260
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Entity Type | Organization
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Legal Business Name | SURVIVORS PATHWAY
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 05/23/2016
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Provider Practice Location Address
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Address Line | 1801 CORAL WAY 2ND FLOOR
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City | MIAMI
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State | FL
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Zip | 33145-2790
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Country | US
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Telephone | 786-275-4364
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Fax | 786-484-0401
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Provider Business Mailing Address
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Address Line | 1801 CORAL WAY 2ND FLOOR
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City | MIAMI
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State | FL
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Zip | 33145-2790
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Country | US
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Telephone | 786-275-4364
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Fax | 786-484-0401
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ANA MARIA VILLAVERDE
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Credential | LCSW
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Telephone | 305-283-2714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9038
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License Number State | FL
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