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General NPI Number Information
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NPI Number | 1750163614
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Entity Type | Organization
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Legal Business Name | SHALOM PSYCHOTHERAPY CENTER LLC
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 7392 NW 35TH TER STE 207-208
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City | MIAMI
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State | FL
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Zip | 33122-1271
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Country | US
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Telephone | 786-353-2347
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Fax | 786-353-2357
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Provider Business Mailing Address
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Address Line | 15622 SW 60TH ST
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City | MIAMI
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State | FL
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Zip | 33193-2820
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Country | US
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Telephone | 305-930-5690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA FERNANDEZ RICHARDSON
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Credential |
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Telephone | 305-930-5690
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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 |
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License Number State |
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