| Public Health Trust Of Miami Dade County Florida | |
|
1611 Nw 12th Ave Miami FL 33136-1005 | |
| (305) 355-7147 | |
| Not Available |
| Full Name | Public Health Trust Of Miami Dade County Florida |
|---|---|
| Speciality | Psychologist |
| Location | 1611 Nw 12th Ave, Miami, Florida |
| Authorized Official Name and Position | Mark T Knight (EXECUTIVE VP, CFO) |
| Authorized Official Contact | 3055858490 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Public Health Trust Of Miami Dade County Florida Po Box 12493 Miami FL 33101-2493 Ph: (305) 585-5315 | Public Health Trust Of Miami Dade County Florida 1611 Nw 12th Ave Miami FL 33136-1005 Ph: (305) 355-7147 |
| NPI Number | 1861151342 |
|---|---|
| Provider Enumeration Date | 12/13/2021 |
| Last Update Date | 12/13/2021 |
| Certification Date | 12/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861151342 | NPI | - | NPPES |
| 106118200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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