Provider Demographics
NPI:1548529712
Name:ESSS
Entity type:Organization
Organization Name:ESSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-375-3293
Mailing Address - Street 1:140 W FLAGLER ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1519
Mailing Address - Country:US
Mailing Address - Phone:305-375-3293
Mailing Address - Fax:305-375-4672
Practice Address - Street 1:140 W FLAGLER ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1519
Practice Address - Country:US
Practice Address - Phone:305-375-3293
Practice Address - Fax:305-375-4672
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIAMI DADE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1113AD057331251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health