Provider Demographics
NPI:1538256177
Name:THE CHILDREN'S PSYCHIATRIC CENTER, INC
Entity type:Organization
Organization Name:THE CHILDREN'S PSYCHIATRIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ON-SITE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMENECH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-274-3172
Mailing Address - Street 1:9380 SW 72ND ST STE B120
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5456
Mailing Address - Country:US
Mailing Address - Phone:305-274-3172
Mailing Address - Fax:305-274-4831
Practice Address - Street 1:9380 SW 72ND ST STE B120
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5456
Practice Address - Country:US
Practice Address - Phone:305-274-3172
Practice Address - Fax:305-274-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health