Individual provider Active NPI

Maria Betina De Souza, PSY D

  • Clinical Psychologist
  • Miami, FL
National Provider Identifier
1245633478
Registry record updated Sep 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY 9085 Issued in FL
Practice address
4500 Biscayne Blvd Ste 202
Miami, FL 33137-3227
Phone
(305) 571-9090
NPI assigned
Oct 2, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY 9085 FL Primary

Addresses

Primary practice location

4500 Biscayne Blvd Ste 202
Miami, FL 33137-3227

Mailing address

4500 Biscayne Blvd Ste 202
Miami, FL 33137-3227
Phone (305) 571-9090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190918001456 FL Practitioner - Clinical Psychologist 2567792518 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4314 NW 71St Dr
Coral Springs, FL 33065-2127
Phone (954) 629-0248

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY 9085FLMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Healing Essence Psychology, LLC Clinical CurrentSince Mar 25, 2019 Accepting new patients
Shin Wellness L L C CurrentSince Sep 15, 2019 Accepting new patients

Locations

4500 Biscayne Blvd
Ste 202
Miami, FL 33137
Phone (305) 431-8939

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1412208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1245633478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 BISCAYNE BLVD STE 202",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331373227",
            "telephone_number": "305-571-9090",
            "fax_number": "305-571-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 BISCAYNE BLVD STE 202",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331373227",
            "telephone_number": "305-571-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE SOUZA",
        "first_name": "MARIA",
        "middle_name": "BETINA",
        "name_prefix": "Dr.",
        "credential": "PSY D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-02",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 9085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.