MEDICARE: PSYCHOTHERAPY SOLUTIONS, INC.

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	251S00000X	Community/Behavioral Health Agency	SW 9371	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174851802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOTHERAPY SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	9055 SW 73RD CT APT 1003
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-2952
Country	:	US
Telephone Number	:	305-669-3835
Fax Number	:	305-669-3875

Provider Business Practice Location Address
First Line	:	7550 SW 57TH AVE STE 112
Second Line	:
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5331
Country	:	US
Telephone Number	:	305-669-3835
Fax Number	:	305-669-3875

Authorized Official
Title or Position	:	LCSW/PRESIDENT
Name	:	MS. NORYS T FERNANDEZ
Credential	:	LCSW, DCSW,SAP,NBCCH
Telephone Number	:	305-669-3835

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	06/19/2011

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