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Organization

DEBORAH M. THEVENIN, PH.D., LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. DEBORAH MORRISON THEVENIN PH.D. (MANAGING MEMBER)
(305) 495-7603
Entity
Organization

Contact information

Practice address
7685 SW 104TH ST, SUITE 100, MIAMI, FL 33156-3161
(305) 666-8000
(305) 666-4311
Mailing address
1500 BAY RD, UNIT 716 SOUTH, MIAMI BEACH, FL 33139-3252
(305) 495-7603
(305) 666-4311

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY4442
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1376846295
NPI TYPE 1
FL
01
FLPY4442
FLORIDA STATE PSYCHOLOGIST LICENSE
FL
Enumeration date
05/26/2014
Last updated
05/26/2014
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