| Shalom Psychotherapy Center Llc | |
|
7392 Nw 35th Ter Ste 207-208 Miami FL 33122-1271 | |
| (786) 353-2347 | |
| (786) 353-2357 |
| Full Name | Shalom Psychotherapy Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7392 Nw 35th Ter Ste 207-208, Miami, Florida |
| Authorized Official Name and Position | Amanda Fernandez Richardson (OWNER) |
| Authorized Official Contact | 3059305690 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shalom Psychotherapy Center Llc 15622 Sw 60th St Miami FL 33193-2820 Ph: (305) 930-5690 | Shalom Psychotherapy Center Llc 7392 Nw 35th Ter Ste 207-208 Miami FL 33122-1271 Ph: (786) 353-2347 |
| NPI Number | 1750163614 |
|---|---|
| Provider Enumeration Date | 10/16/2023 |
| Last Update Date | 11/20/2024 |
| Certification Date | 11/20/2024 |
| Medicare PECOS PAC ID | 5698212140 |
|---|---|
| Medicare Enrollment ID | O20240801004669 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750163614 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Carlos Ernesto Rodriguez Garcia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225734940 PECOS PAC ID: 8224473012 Enrollment ID: I20240304000112 |
| Provider Name | Dalgys Perez Lujan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184262818 PECOS PAC ID: 3072959253 Enrollment ID: I20240311000916 |
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