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General NPI Number Information
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NPI Number | 1982725479
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CENTER FOR CHILDREN AND ADOLESCENTS
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 2519 GALIANO ST SUITE 712
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City | CORAL GABLES
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State | FL
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Zip | 33134-6132
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Country | US
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Telephone | 305-446-7673
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Fax | 305-446-1440
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Provider Business Mailing Address
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Address Line | 2519 GALIANO ST SUITE 712
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City | CORAL GABLES
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State | FL
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Zip | 33134-6132
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Country | US
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Telephone | 305-446-7673
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Fax | 305-446-1440
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARISA AZARET
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Credential | PSY D
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Telephone | 305-446-7673
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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 |
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License Number State | FL
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