Provider Demographics
NPI:1265226047
Name:ICV PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:ICV PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILAINY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-763-0497
Mailing Address - Street 1:2266 NW 99TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2138
Mailing Address - Country:US
Mailing Address - Phone:305-763-0497
Mailing Address - Fax:
Practice Address - Street 1:2266 NW 99TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2138
Practice Address - Country:US
Practice Address - Phone:305-763-0497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty