Doctor Name: | MISS DALAD SRISUPPAK |
NPI Number: | 1235572397 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RMHCI |
License Number: | IMH12050 |
Business Practice Address: | 1870 Forest Hill Blvd 200 West Palm Beach, FL - 334068901 |
Business Phone Number: | 5619046514 |
Business Fax Number: | 5617764213 |
Mailing Address: | 1870 Forest Hill Blvd, Suite 200 WEST PALM BEACH |
State: | FL |
Postal Code: | 334068901 |
Phone Number: | 5619046514 |
Fax Number: | 5617764213 |
NPI Enumeration Date: | 04/09/2013 |
NPI Last Update Date: | 03/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | IMH12050 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |