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General NPI Number Information
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NPI Number | 1982945390
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Entity Type | Organization
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Legal Business Name | AMY SMALL, LLC
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 12550 BISCAYNE BLVD SUITE 408
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2541
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Country | US
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Telephone | 305-607-4643
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Fax | 305-866-3454
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Provider Business Mailing Address
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Address Line | 12550 BISCAYNE BLVD STE 408
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2544
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Country | US
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Telephone | 305-607-4643
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Fax | 305-866-3454
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. AMY MICHELLE SMALL
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Credential | L.C.S.W.
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Telephone | 305-607-4643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9928
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License Number State | FL
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