Provider Demographics
NPI:1588071831
Name:MIAMIPSYCDOC, LLC
Entity type:Organization
Organization Name:MIAMIPSYCDOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:S
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:305-501-0046
Mailing Address - Street 1:6705 RED ROAD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3649
Mailing Address - Country:US
Mailing Address - Phone:305-501-0046
Mailing Address - Fax:
Practice Address - Street 1:6705 RED ROAD
Practice Address - Street 2:SUITE 610
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-3649
Practice Address - Country:US
Practice Address - Phone:305-501-0046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7479103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty