Provider Demographics
NPI:1902158314
Name:PARENT-CHILD BEHAVIOR CLINIC, INC.
Entity Type:Organization
Organization Name:PARENT-CHILD BEHAVIOR CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ISOM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-652-1081
Mailing Address - Street 1:111 NW 183RD ST
Mailing Address - Street 2:SUITE 351
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4537
Mailing Address - Country:US
Mailing Address - Phone:305-652-1081
Mailing Address - Fax:305-652-3095
Practice Address - Street 1:111 NW 183RD ST
Practice Address - Street 2:SUITE 351
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4537
Practice Address - Country:US
Practice Address - Phone:305-652-1081
Practice Address - Fax:305-652-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3916251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health