Provider Demographics
NPI:1215307491
Name:PSYCHOLOGICAL ASSOCIATION OF SOUTH FLORIDA, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATION OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:CHANTAL
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-901-7350
Mailing Address - Street 1:11301 S DIXIE HWY UNIT 565392
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-7222
Mailing Address - Country:US
Mailing Address - Phone:305-901-7350
Mailing Address - Fax:
Practice Address - Street 1:1550 MADRUGA AVE STE 510
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3048
Practice Address - Country:US
Practice Address - Phone:305-901-7350
Practice Address - Fax:786-615-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7973103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty