MEDICARE: MIAMI INTEGRATED PSYCHOLOGY

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1598323651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI INTEGRATED PSYCHOLOGY

Provider Business Mailing Address
First Line	:	1001 BRICKELL BAY DR STE 2727
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-4900
Country	:	US
Telephone Number	:	305-902-4480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 BRICKELL BAY DR STE 2727
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-4900
Country	:	US
Telephone Number	:	305-902-4480
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. IVELISSE MARIE BARREIRO ROSADO
Credential	:	PSY.D.
Telephone Number	:	305-902-4480

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	06/04/2019

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