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General NPI Number Information
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NPI Number | 1689126161
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Entity Type | Organization
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Legal Business Name | TEEN ADDICTION TREATMENT, INC.
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 1515 NW 167TH ST #430
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City | MIAMI
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State | FL
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Zip | 33169-5100
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Country | US
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Telephone | 786-923-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 NW 167TH ST #430
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City | MIAMI
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State | FL
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Zip | 33169-5100
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Country | US
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Telephone | 786-923-3310
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT NIZNIK
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Credential |
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Telephone | 786-923-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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