| Actual Psych Group Llc | |
|
33 W 26th St Hialeah FL 33010-1707 | |
| (305) 887-4163 | |
| Not Available |
| Full Name | Actual Psych Group Llc |
|---|---|
| Speciality | Social Worker |
| Location | 33 W 26th St, Hialeah, Florida |
| Authorized Official Name and Position | Liset Fiallo (PRESIDENT) |
| Authorized Official Contact | 3052835497 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Actual Psych Group Llc 1421 Sw 124th Ct Apt C Miami FL 33184-2605 Ph: (305) 283-5497 | Actual Psych Group Llc 33 W 26th St Hialeah FL 33010-1707 Ph: (305) 887-4163 |
| NPI Number | 1790224624 |
|---|---|
| Provider Enumeration Date | 02/12/2017 |
| Last Update Date | 02/12/2017 |
| Medicare PECOS PAC ID | 2860760154 |
|---|---|
| Medicare Enrollment ID | O20170608002540 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790224624 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW14095 (Florida) | Primary |
| Provider Name | Liset Fiallo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346789278 PECOS PAC ID: 0941578231 Enrollment ID: I20170608002602 |
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