=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851795181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAYA BAT-AMI PSYD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2014
-----------------------------------------------------
Last Update Date | 10/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 E HALLANDALE BEACH BLVD SUITE 1006
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-454-5500
-----------------------------------------------------
Fax | 866-538-4649
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 S OCEAN DR #4-A
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33019-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-454-5500
-----------------------------------------------------
Fax | 866-538-4649
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. MAYA BAT-AMI
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 954-454-5500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PY0004549
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------