Phoenix House of Support Corp

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

016029700 Issued in FL

Legal business name

PHOENIX HOUSE OF SUPPORT CORP

Practice address

8902 SW 208TH Ter
Cutler Bay, FL 33189-3884

Phone

(786) 301-1571

Fax

(305) 233-8594

NPI assigned

Aug 30, 2016

Organization subpart

No

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

Authorized official

Name

Tamara ViquillonNPI 1073964326

Title

Owner

Phone

(786) 301-1571

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tamara Viquillon

  • Behavior Analyst
  • Miami, FL
  • NPI 1073964326
  NPD (past) Authorized official

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

{
    "created_epoch": "1472515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472515200000",
    "number": "1356897300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8902 SW 208TH TER",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331893884",
            "telephone_number": "786-301-1571",
            "fax_number": "305-233-8594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8902 SW 208TH TER",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331893884",
            "telephone_number": "786-301-1571",
            "fax_number": "305-233-8594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HOUSE OF SUPPORT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-30",
        "last_updated": "2016-08-30",
        "status": "A",
        "authorized_official_last_name": "VIQUILLON",
        "authorized_official_first_name": "TAMARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-301-1571"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "016029700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016029700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary L Petras, LCSW
• Barbara Marlen Pfeiffer, SLP
• Jeanette Philipp-Pizarro, PROGRAM THERAPIST
• Elizabeth J-M Philippe, MD
• Patricia Marie Jose Philippe, APRN
• PHP Mental Health Center Inc
• PHP Mental Health Center Inc
• Physical Therapy Time
• Physician Group of South Florida Inc
• Physicians Elite Care LLC

• Behavior Analyst in Cutler Bay, FL
• Providers in Cutler Bay, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.