Organization
ACTUAL PSYCH GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISET FIALLO (PRESIDENT)
(305) 283-5497
Entity
Organization
Contact information
Practice address
33 W 26TH ST, HIALEAH, FL 33010-1707
(305) 887-4163
Mailing address
1421 SW 124TH CT, APT C, MIAMI, FL 33184-2605
(305) 283-5497
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW14095
FL
Other
Enumeration date
02/12/2017
Last updated
02/12/2017
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