=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982390704
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANTANA PSYCH-EDUCATIONAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2023
-----------------------------------------------------
Last Update Date | 04/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10661 N KENDALL DR STE 232
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-558-9123
-----------------------------------------------------
Fax | 786-558-9123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9801 SW 74TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33173-3175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-606-5398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SCHOOL PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | MRS. GEMA M. SANTANA
-----------------------------------------------------
Credential | LSP
-----------------------------------------------------
Telephone | 305-606-5398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------