Provider Demographics
NPI:1194942409
Name:MIAMI-DADE JUVENILE SERVICES DEPARTMENT
Entity type:Organization
Organization Name:MIAMI-DADE JUVENILE SERVICES DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WANSLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-755-6202
Mailing Address - Street 1:275 NW 2ND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1741
Mailing Address - Country:US
Mailing Address - Phone:305-755-6202
Mailing Address - Fax:
Practice Address - Street 1:275 NW 2ND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1741
Practice Address - Country:US
Practice Address - Phone:305-755-6202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI DADE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD057313251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health