=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700921475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELF AWARENESS WORKSHOP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 S DIXIE HWY SUITE 4A
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-666-7353
-----------------------------------------------------
Fax | 305-666-7353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 S DIXIE HWY
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-666-7353
-----------------------------------------------------
Fax | 305-666-7353
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DR. SUE B. GRIFFITHS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 305-666-7353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY0003434
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------