Provider Demographics
NPI:1043752389
Name:GATEWELL THERAPY CENTER
Entity type:Organization
Organization Name:GATEWELL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-846-9370
Mailing Address - Street 1:4601 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2111
Mailing Address - Country:US
Mailing Address - Phone:305-846-9370
Mailing Address - Fax:
Practice Address - Street 1:4601 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2111
Practice Address - Country:US
Practice Address - Phone:305-846-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty