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General NPI Number Information
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NPI Number | 1790803922
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Entity Type | Individual
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Provider Name | MIKHEL CHARLES BUCK LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1800 NORTHEAST 114 STREET 801
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City | NORTH MIAMI
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State | FL
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Zip | 33181-3417
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Country | US
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Telephone | 305-891-1067
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Fax | 305-891-1067
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Provider Business Mailing Address
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Address Line | 1800 NORTHEAST 114 STREET 801
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City | NORTH MIAMI
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State | FL
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Zip | 33181-3417
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Country | US
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Telephone | 305-891-1067
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Fax | 305-891-1067
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | SW0002763
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License Number State | FL
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