Provider Demographics
NPI:1316167919
Name:PSYCHOSOMA, INC.
Entity type:Organization
Organization Name:PSYCHOSOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MADERAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MDIV
Authorized Official - Phone:305-221-5366
Mailing Address - Street 1:6750 SW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3252
Mailing Address - Country:US
Mailing Address - Phone:305-221-5366
Mailing Address - Fax:305-667-9496
Practice Address - Street 1:8766 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3201
Practice Address - Country:US
Practice Address - Phone:305-221-5366
Practice Address - Fax:305-667-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty