Provider Demographics
NPI:1447436340
Name:DMHG PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:DMHG PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGMR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DECRUISE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-877-7051
Mailing Address - Street 1:4963 SW 128TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5508
Mailing Address - Country:US
Mailing Address - Phone:305-877-7051
Mailing Address - Fax:
Practice Address - Street 1:4963 SW 128TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5508
Practice Address - Country:US
Practice Address - Phone:305-877-7051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7636103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty