Organization
MIVIP BEHAVIORAL HEALTH LLC
Active
Parent organization
MIVIP MEDICAL GROUP INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIVIP MEDICAL GROUP INC
Authorized official
ISAAC VERBUKH (PRESIDENT)
(561) 392-3341
Entity
Organization
Contact information
Practice address
3475 SHERIDAN ST, 101, HOLLYWOOD, FL 33021-3663
(855) 496-4847
Mailing address
398 CAMINO GARDENS BLVD, 102, BOCA RATON, FL 33432-5827
(561) 392-3341
(561) 829-5482
Taxonomy
Speciality
Code
Description
License number
State
103TH0004X
Health Psychologist
Primary
—
—
Other
Enumeration date
01/15/2015
Last updated
01/15/2015
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