Provider Demographics
NPI:1316148349
Name:HEALTH PSYCHOLOGICAL GROUP INC
Entity type:Organization
Organization Name:HEALTH PSYCHOLOGICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:A
Authorized Official - Last Name:FONTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-423-7062
Mailing Address - Street 1:80 SW 8TH ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-3003
Mailing Address - Country:US
Mailing Address - Phone:305-423-7062
Mailing Address - Fax:305-423-7162
Practice Address - Street 1:80 SW 8TH ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3003
Practice Address - Country:US
Practice Address - Phone:305-423-7062
Practice Address - Fax:305-423-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY005001103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN NUMBER