NPIMap

Organization Active NPI

Mindbody Connection

  • Clinical Psychologist
  • Aventura, FL
National Provider Identifier
1124364104
Registry record updated Dec 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY 8498 Issued in FL
Legal business name
MINDBODY CONNECTION
Practice address
2875 NE 191St St
#538
Aventura, FL 33180-2801
Phone
(754) 300-9386
Fax
(786) 923-0947
NPI assigned
Dec 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mariam Dum, PH.D.
Title
Clinical Psychologist
Phone
(786) 553-4546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X PY 8498 FL Primary

Addresses

Primary practice location

2875 NE 191St St
#538
Aventura, FL 33180-2801

Mailing address

2121 SW 3Rd Ave
200
Miami, FL 33129-1490
Phone (786) 553-4546

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355961600000",
    "number": "1124364104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 SW 3RD AVE",
            "address_2": "200",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331291490",
            "telephone_number": "786-553-4546",
            "fax_number": "786-923-0947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2875 NE 191ST ST",
            "address_2": "#538",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "331802801",
            "telephone_number": "754-300-9386",
            "fax_number": "786-923-0947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBODY CONNECTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-20",
        "last_updated": "2012-12-20",
        "status": "A",
        "authorized_official_last_name": "DUM",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "786-553-4546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 8498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Aventura, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.