Provider Demographics
NPI:1699048538
Name:PEDIATRIC & ADULT COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:PEDIATRIC & ADULT COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:ALESSIO
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-804-7843
Mailing Address - Street 1:1042 NW 159TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1609
Mailing Address - Country:US
Mailing Address - Phone:305-804-7843
Mailing Address - Fax:786-664-3379
Practice Address - Street 1:17071 W DIXIE HWY
Practice Address - Street 2:STE 103
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3773
Practice Address - Country:US
Practice Address - Phone:305-804-7843
Practice Address - Fax:786-664-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW68421041C0700X
FLMT2219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty