# NICKLAUS CHILDREN'S PEDIATRIC SPECIALISTS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Nicklaus Children's Pediatric Specialists - Psychiatry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194277756
- **Authorized official:** MARCOS MESTRE (SVP)
- **Authorized official phone:** (305) 666-6511

## Contact information

- **Practice address:** 3100 SW 62ND AVE, DEPARTMENT OF PSYCHOLOGY, MIAMI, FL 33155-3009
- **Practice address phone:** (786) 624-5876
- **Practice address fax:** (786) 624-2688
- **Mailing address:** PO BOX 947095, ATLANTA, GA 30394-7095
- **Mailing address phone:** (786) 624-5876
- **Mailing address fax:** (786) 624-2688

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 10/31/2016
- **Last updated:** 11/12/2024