MEDICARE: HEALING ESSENCE PSYCHOLOGY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1063971851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING ESSENCE PSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	4500 BISCAYNE BLVD STE 202
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-3227
Country	:	US
Telephone Number	:	305-571-9090
Fax Number	:	305-571-7800

Provider Business Practice Location Address
First Line	:	4500 BISCAYNE BLVD STE 202
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-3227
Country	:	US
Telephone Number	:	305-571-9090
Fax Number	:	305-571-7800

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. MARIA BETINA DE SOUZA
Credential	:	PSY D
Telephone Number	:	954-629-0248

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	09/11/2019

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