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General NPI Number Information
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NPI Number | 1972105369
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Entity Type | Organization
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Legal Business Name | CARDINALS CARE C.M.H.C.
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 11/11/2020
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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 | PRESIDENT
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Name | 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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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