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General NPI Number Information
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NPI Number | 1790189405
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Entity Type | Organization
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Legal Business Name | DLN BEHAVIORAL, INC.
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Dates
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Enumeration Date | 10/09/2014
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 2100 PONCE DE LEON BLVD STE 1015
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City | CORAL GABLES
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State | FL
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Zip | 33134-5240
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Country | US
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Telephone | 786-797-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 PONCE DE LEON BLVD STE 1015
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City | CORAL GABLES
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State | FL
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Zip | 33134-5240
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Country | US
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Telephone | 786-797-7788
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LAURA DE LA NUEZ
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Credential | PSY. D.
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Telephone | 786-797-7788
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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 | PY7224
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License Number State | FL
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