| Entity Name: | DEBORAH M. THEVENIN, PH.D., LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Dec 2010 (14 years ago) |
| Document Number: | L10000129407 |
| FEI/EIN Number | 274367449 |
| Mail Address: | 1330 West Ave, MIAMI BEACH, FL, 33139, US |
| Address: | 1330 West Avenue, MIami Beach, FL, 33139, US |
| ZIP code: | 33139 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003228032 | 2014-05-26 | 2014-05-26 | 1500 BAY RD, UNIT 716 SOUTH, MIAMI BEACH, FL, 331393252, US | 7685 SW 104TH ST, SUITE 100, MIAMI, FL, 331563161, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 305-495-7603 |
| Fax | 3056664311 |
| Phone | +1 305-666-8000 |
Authorized person
| Name | DR. DEBORAH MORRISON THEVENIN |
| Role | MANAGING MEMBER |
| Phone | 3054957603 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY4442 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI TYPE 1 |
| Number | 1376846295 |
| State | FL |
| Issuer | FLORIDA STATE PSYCHOLOGIST LICENSE |
| Number | FLPY4442 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| STARK STEVEN EEsq. | Agent | 1330 West Ave, MIAMI BEACH, FL, 33139 |
| Name | Role | Address |
|---|---|---|
| THEVENIN DEBORAH MPhd | Managing Member | 1330 West Avenue, MIami Beach, FL, 33139 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-26 | 1330 West Avenue, Apt. 2202, MIami Beach, FL 33139 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-26 | 1330 West Avenue, Apt. 2202, MIami Beach, FL 33139 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-26 | 1330 West Ave, Apt. 2202, MIAMI BEACH, FL 33139 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-30 | STARK, STEVEN E., Esq. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-02 |
| ANNUAL REPORT | 2023-03-26 |
| ANNUAL REPORT | 2022-02-12 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-02-24 |
| ANNUAL REPORT | 2019-06-12 |
| ANNUAL REPORT | 2018-04-10 |
| ANNUAL REPORT | 2017-01-14 |
| ANNUAL REPORT | 2016-03-05 |
| ANNUAL REPORT | 2015-01-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
