Dr. Maria Zayas Bazan _ MIAMTEACH CI Y OF MIAMI BEACH
BOARDS ADD COMMITTEE APPLICATION FORM
NAME: %5 -,-
ZA-?-A N W!�R:Lft• .
Last Name
^ \ n� First Name Middle Initial
HOME ADDRESS:,_),3o &tJ 26 3 �' 3 Sod 1
No. Street City State Zip Code
PHONE: 3 o s 15 .5 O_:? M f1i't rr�n zau!as 6Q-�iGt.4l)• �M
_wertte- ce ` Work Fax Email ad ress
Business Name: Position: (4
Q,Jn
Address:
a"AA 11 1102424 rc'
No. _ Street City State Zip Code
Professional License(describe Expires: Attach a copy of the license
Pursuant to City Code section 2-22(4)a and b: Members of agencies, boards, and committees shall be affiliated with the city; this
requirement shall be fulfilled in the following ways: a) an individual shall have been a resident of the city for a minimum of six
months; or b)an individual shall demonstrate ownership/interest for a minimum of six months in a business established in the city.
• Resident of Miami Beach for a minimum of six(6) months: Yes❑or No C�
• Demonstrate an ownership/interest in a business in Miami Beach for a minimum of six(6) months: Yes YborNo ❑
• Are you a registered voter in Miami Beach: Yes ❑or No
• (Please check one): I am now a resident of: North Beach ❑South Beach ❑ Middle Beach ❑
• I am applying for an appointment because I have special abilities, knowledge, experience. Please list below:
ComQS�%e 6 ole n&, CA •I ri f ` SI t
Please list your preferences in order of ranking [1] first choice[2] second choice, and [3]third choice. Please note that only three(3)
choices will be observed by the City Clerk's Office.(Regular Boards of City)
❑Art in Public Places Committee 0 Housing Authority*
❑Beach Preservation Board 0 Loan Review Committee*
❑Beautification Committee ❑Mayor's Green Ad-Hoc Committee
0 Board of Adjustment* ❑Marine Authority*
❑Budget Advisory Committee 0 Miami Beach Cultural Arts Council
❑Committee on Homeless 11"iami Beach Commission on Status of Women
❑Committee for Quality Education in MB ❑Miami Beach Florida Sister Cities
❑Community Development Advisory* ❑Normandy Shores Local Gov't Neigh. Improvement
Community Relations Board 0 Oversight Committee for General Obligation Bond
❑Convention Center Advisory Board ❑Parks and Recreation Facilities Board
❑Debarment Committee ❑Personnel Board*
❑Design Review Board* ❑Planning Board*
❑Disability Access Committee ❑ Police Citizens Relations Committee
❑Fine Arts Board 0 Production Industry Council
❑Golf Advisory Committee 0 Public Safety Advisory Committee
❑Health Advisory Committee ❑Safety Committee
0 Health Facilities Authority Board 0 Transportation and Parking Committee
17 Hispanic Affairs Committee 0 Visitor and Convention Authority*
❑Historic Preservation Board* ❑Youth Center Advisory Board
*Board Required to File State Disclosure form
C.t[:iccurncnts and Ie!uR)rary lnternet f iiesV:11,MC5M,3C.,Application Reuisod July 18 2,OC7.doc.
Note: If applying for Youth Advisory Board, please indicate your affiliation with the Scott Rakow Youth Center:
1. Past service on the Youth Center Advisory Board:Yes❑No❑ Years of Service:
2. Present participation in Youth Center activities by your children Yes❑ No ❑. If yes, please list the names of your children, their
ages, and which programs. List below:
Child's name: Age: Program:
Child's name: Age: Program:
*Have you ever been convicted of a felony: Yes 0 or No✓If yes, please explain in detail:
• Do you currently have a violation(s) of City of Miami Beach codes: Yes❑or No V*'If yes, please explain in detail:
• Do you currently owe the City of Miami Beach any money: Yes❑or No Gt' If yes, explain in detail
• Are you currently serving on any City Boards or Committees: Yes ❑or No �. If yes; which board?
• What organizations in the City of Miami Beach do you currently hold membership in? r_ _
Name: Title: .e r n,� 6 S
Name: Title:
• List all properties owned or have an interest in, which are located within the City of Miami Beach:
�1 u ��neo�,►.�po�cT� W00 � •L C• 31 a Q & o�
• I am now employed by the City of Miami Beach: Yes� or No❑. Which department?
o Pursuant to City Code Section 2-25(b): Do you have a parent❑, spouse❑, child❑, brother❑, or sister❑who is employed by the
City of Miami Beach?Check all that apply. Identify the department(s):
Nonce
This section is"not required"but desired: Age: q.L years old Gender: Male❑ Female k_,�
Ethnic Origin (Check one) /
White❑African-American/Black 0 Hispanic: 54 Asian or Pacific Islander 0 American Indian or Alaskan Native❑
Employment Status: Employed V1RetirHome-maker❑Other❑
"I hereby attest to the accuracy and truthfulness of the application and have received, read and will abide by Chapter 2,
Article VII— f tandards of Conduct for City Officers, Employees and Agency Members."
Rz A �$
n Da a Name of Applicant(PLEASE PRINT)
Please attach a copy of your resume to this application
NOTE:Applications will remain on file for a period of one(1)calendar year.
Received in City Clerk's Office by Date
Name of Deputy Clerk
Document Control Number(Assigned by the City Clerk's Office) Z,z- Entered By Date 3v
R ised 125/07 jo
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Maria M. Zayas-Bazan, LM HC, Psy.D.
1111 Lincoln Road, Suite 400
Miami Beach, Fl 33129
(305) 815-5903
EDUCATION
2001 Doctor of Psychology
Carlos Albizu University
Miami Campus
1994 Master of Science in Psychology
Miami Institute of Psychology
Caribbean Center for Advanced Studies
Graduated with Utmost Distinction
1993 Bachelor of Arts in Psychology
University of Miami
1989 Associate of Arts in Psychology
Miami Dade Community College, North Campus
LICENSUREXERTIFICATION
2007 Licensed Psychologist in the state of Florida(License# PY7521)
2003 Hypnotherapist(70 hours of training)
2000 Licensed Mental Health Counselor(LMHC) State of Florida
(License# MH5974)
2000 Certified Trainer for the Iowa Strengthening Families Program: For Parents
and Youth 10-14
2000 Certified as an Official FARS and CFARS Rater
1
WORK EXPERIENCE
2013 Licensed Clinical Psychologist
Orlandini Psychological Group
Provide psychotherapeutic services in English and Spanish to individuals,
couples, families and groups treating a wide range of issues. Specialties
include Cognitive Behavior Therapy(CBT), hypnotherapy, stress
management, emotional dysregulation, depression, anxiety,
marital/partner/family therapy and GLBT issues.
2007 -2013 Vice-President of Behavioral Health
Miami Beach Community Health Center, Inc.
Resigned my position to work in private practice. Performed administrative
duties including but not limited to coordination of all behavioral health
services, monitoring of census, establishing community ties, developing
grants, providing community education on mental health issues,developing
healthcare plan goals and objectives, supervising the department/clinicians,
and conducting monthly staff meetings and trainings. Also provided
outpatient psychotherapy and monitored compliance. Acted as member of the
Executive Total Quality Management Committee, Directors Committee,
Senior Providers Committee, Re-engineering Committee, Infection Control
Committee, Electronic Health Record Committee, Compliance Committee,
Credentialing Committee and Patient Care and Safety Committee.
2007 Resigned my position as a Licensed Mental Health Counselor at Citrus Health
Network to dedicate myself to preparing for and passing the EPPP exam in
Professional Practice of Psychology and the Florida Laws and Rules Exam.
2006-2006 Licensed Mental Health Counselor
Citrus Mental Health Network
Children and Adolescent Treatment Center(CATS)
Worked as part of an inter-disciplinary team providing consultation and
psychotherapeutic services in English and Spanish to adolescent clients who
have had substance abuse issues, sexual abuse, prostitution, engaged in self-
injurious behavior, hostile and aggressive acts out of proportion with the
situation, a pattern of risk taking activities, and past elopements from different
therapeutic programs. Also attended Miami-Dade County and Broward
County Courts with the clients to provide the courts with written and verbal
feedback on client motivation, progress, and obstacles to a successful
therapeutic outcome. Was an active participant in weekly rounds with the
inter-disciplinary team where aspects of client care were addressed. Other
services provided were crisis management as well as monitoring the
restraining of the clients when they posed a danger to themselves or others
and were unresponsive to professional therapeutic de-escalation techniques.
Also monitored, when necessary, the administration of intra muscular
injection prescribed by staff psychiatrist to decrease the client's agitation and
decrease risk of harm to self or others. Provided staff training on improving
compliance and communication with the clients to decrease the incidence of
2
escalating behavior. Provided a training seminar at Citrus Health Network on
Psychological Treatment of Terminal Ill Patients.
2004 —2006 Post-Doctoral Psychology Fellow
University of Miami Jackson Memorial Hospital
Sylvester Comprehensive Cancer Center
Conducted in-patient consultations, evaluations, as well as provided out-
patient psychotherapy. Performed Bone Marrow Transplant Evaluations, Pain
Evaluations and worked as part of the Kessenich Family ALS, MDA
interdisciplinary team.
2002—2004 Licensed Mental Health Counselor in Private Practice
Provided psychotherapy and crisis intervention to individuals, families and
children. Specialize in mood disorders and ADHD. Services provided in
English and Spanish.
2002-2003 Psychotherapist
Hurwitz Child Crisis Nursery
Provided group and individual counseling to children with a history of abuse
and neglect that had been removed from their homes by DCF.
2001 —2002 Chief Post-Doctoral Psychology Fellow
University of Miami/Jackson Memorial Hospital
Sylvester Comprehensive Cancer Center
Worked as part of an inter-disciplinary team providing consultation and
psychotherapeutic services in English and Spanish to Oncology in-patients
and out-patients. Provided diagnostic and psychotherapeutic services on a
weekly basis to general internal medicine out-patients. The Courtelis Center
also provides services to non-medical patients requesting psychotherapy.
Facilitated monthly relaxation training groups to Oncology patients and their
families. Attended weekly psychiatric grand rounds and participated in in-
patient rounds. Provided an in-service on relaxation training for CEU's. Also
performed administrative duties as Chief Fellow.
2000—2001 Psychotherapist
Citrus Health Network(CHN)
Worked as part of an inter-disciplinary team in the Partial Hospitalization
Program (PHP) and the Outpatient Program. Performed intake interviews,
admissions assessments, psychosocials, formulated treatment plans, and made
appropriate referrals. Provided individual, family, and group therapy as well
as crisis intervention to individuals with a variety of disorders, including
physical health issues. Additionally, worked in the Children's Substance
Abuse Prevention Program(CSAPP) providing intensive therapeutic on site
services including individual and family therapy in the client's homes.
Performed substance abuse psychosocial assessments, formulated treatment
plans, quarterly reviews, CFARS Outcome Measures, ASAMs, SISARs,and
center wide and program discharge summaries as per Medicaid guidelines.
Provided verbal and written progress summaries when necessary to the
Miami-Dade County Court, Substituted for program directors due to vacations
3
for one week in CSAPP,two weeks in the PHP, and two weeks in the
outpatient assessment unit. Also conducted utilization review and provided
certification training on a module of the Iowa Strengthening Families
Program.
1998 — 1999 Psychology Intern
Miami Dade Office of Youth and family Development
Early Intervention Development Center (EIDQ
Worked as part of an inter-disciplinary team serving a population consisting
of severely emotionally disturbed children and their families. Performed
intake interviews, psychosocial assessments, formulated treatment plans and
composed weekly rehab summaries as well as quarterly reviews of client
progress compliant with Medicaid guidelines. Provided updates to the
respective guardian agencies as well as written reports on client progress
when necessary. Psychological assessments were also performed. Provided
individual, marriage, family, and group therapy as well as crisis intervention
and case management.
1998 Research Assistant
University of Miami/Jackson Memorial Hospital
SMART/EST Women's Project
Provided group therapy to a female HIV positive population. Worked as part
of the Cultural Linguistics Working Group back translating assessment
measures. Provided initial recruitment coordination services for the Spanish
portion of the project. Also performed data entry services and participated in
weekly research meetings
1996- 1998 Consultant and Therapist
Greater Miami Adult Day Center
Performed initial assessments, formulated treatment plans, provided
individual counseling, and facilitated groups for patients whose health issues
exacerbated their psychiatric illness. Was also responsible for providing
private individual and family counseling on a self-pay basis under the
supervision of a Licensed Mental Health Counselor.
1995- 1997 Substitute Teacher
Dade County Puhlic School Board
Certified in Psychology, English, and Sociology
1995 Independent Support Coordinator
Choices in Support and Services, Inc.
Provided individual and family therapy, case management, and organized and
formulated support plans and cost plans for a developmentally disabled
population.
1995 Psychotherapist
Parkday Center at Parkway Hospital
Provided group counseling services.
4
1994 Psychotherapist
Various Adult Congregate Living Facilities
Provided group and individual counseling as well as developing and
implementing specific therapeutic interventions.
1994 Psychotherapist
Southern Winds Psychiatric Hospital
Provided group counseling services as part of a multi-disciplinary team.
Developed and implemented a variety of group topics.
PRACTICUM EXPERIENCE
1997 - 1998 Practicum Student
University of Miami/Jackson Memorial Hospital
Provided consultation liaison services to HIV positive individuals and their
families. Also performed neuropsychological testing on pre and post kidney
and heart transplant patients at the Biobehavioral Medicine Division.
Individual counseling was provided on an as needed basis.
1996— 1997 Therapist
Mental Health Association
Provided individual and family counseling, developed treatment plans and
performed psychological testing on a homeless population.
1995 Therapist
Goodman Psychological Services Center
Performed intake assessments, psychosocial, and developed treatment plans.
Provided individual, family, and couples therapy.
1994 Primary Counselor
Juvenile Diversionary Program
Performed intake assessments, psychosocials, and formulated treatment plans.
Provided individual, family and marriage counseling,crisis intervention,and
case management to first tine adolescent offenders and their families.
1994 Therapist
Charter Hospital of Miami
Performed psychosocial assessments, psychosocial addendums, formulated
treatment plans, and facilitated and co-facilitated groups.
Individual therapy was also provided.
5
RESEARCH
1990 - 1991 Research Assistant
University of Miami
Childhood Mobility Project
Performed structured interviews, administered and scored personality tests,
and provided data entry services.
VOLUNTEER WOORK
1998 Volunteer Worker
University of Mianu/Jackson Memorial Hospital
Torture Pilot Study
Perfonned back translation services on assessment measures.
MEMBERSHIPS
2007 - Present Member of the Douglas Gardens Board of Directors
1999—Present American Psychological Association member
1994—Present PsiChi member in good standing(Psychology Honors Society)
LANGUAGES
Fluent in English and Spanish
6
i
Maria M. Zayas-Bazan, LMHC, Psy.D.
1111 Lincoln Road, Suite 400
Miami Beach, Fl 33129
(305) 815-5903
EDUCATION
2001 Doctor of Psychology
Carlos Albizu University
Miami Campus
1994 Master of Science in Psychology
Miami Institute of Psychology
Caribbean Center for Advanced Studies
Graduated with Utmost Distinction
1993 Bachelor of Arts in Psychology
University of Miami
1989 Associate of Arts in Psychology
Miami Dade Community College, North Campus
LICENSURE/CERTIFICATION
2007 Licensed Psychologist in the state of Florida(License# PY7521)
2003 Hypnotherapist(70 hours of training)
2000 Licensed Mental Health Counselor(LMHC) State of Florida
(License# MH5974)
2000 Certified Trainer for the Iowa Strengthening Families Program: For Parents
and Youth 10-14
2000 Certified as an Official FARS and CFARS Rater
1
i
\1
WORK EXPERIENCE
2013 Licensed Clinical Psychologist
Orlandini Psychological Group
Provide psychotherapeutic services in English and Spanish to individuals,
couples, families and groups treating a wide range of issues. Specialties
include Cognitive Behavior Therapy(CBT),hypnotherapy, stress
management, emotional dysregulation,depression, anxiety,
marital/partner/family therapy and GLBT issues.
2007 - 2013 Vice-President of Behavioral Health
Miami Beach Community Health Center, Inc.
Resigned my position to work in private practice. Performed administrative
duties including but not limited to coordination of all behavioral health
services, monitoring of census, establishing community ties, developing
grants, providing community education on mental health issues,developing
healthcare plan goals and objectives, supervising the department/clinicians,
and conducting monthly staff meetings and trainings. Also provided
outpatient psychotherapy and monitored compliance. Acted as member of the
Executive Total Quality Management Committee, Directors Committee,
Senior Providers Committee, Re-engineering Committee, Infection Control
Committee, Electronic Health Record Committee, Compliance Committee,
Credentialing Committee and Patient Care and Safety Committee.
2007 Resigned my position as a Licensed Mental Health Counselor at Citrus Health
Network to dedicate myself to preparing for and passing the EPPP exam in
Professional Practice of Psychology and the Florida Laws and Rules Exam.
2006-2006 Licensed Mental Health Counselor
Citrus Mental Health Network
Children and Adolescent Treatment Center (CATS)
Worked as part of an inter-disciplinary team providing consultation and
psychotherapeutic services in English and Spanish to adolescent clients who
have had substance abuse issues, sexual abuse, prostitution, engaged in self-
injurious behavior, hostile and aggressive acts out of proportion with the
situation, a pattern of risk taking activities, and past elopements from different
therapeutic programs. Also attended Miami-Dade County and Broward
County Courts with the clients to provide the courts with written and verbal
feedback on client motivation, progress, and obstacles to a successful
therapeutic outcome. Was an active participant in weekly rounds with the
inter-disciplinary team where aspects of client care were addressed. Other
services provided were crisis management as well as monitoring the
restraining of the clients when they posed a danger to themselves or others
and were unresponsive to professional therapeutic de-escalation techniques.
Also monitored, when necessary, the administration of intra muscular
injection prescribed by staff psychiatrist to decrease the client's agitation and
decrease risk of harm to self or others. Provided staff training on improving
compliance and communication with the clients to decrease the incidence of
2
escalating behavior. Provided a training seminar at Citrus Health Network on
Psychological Treatment of Terminal III Patients.
2004—2006 Post-Doctoral Psychology Fellow
University of Miami Jackson Memorial Hospital
Sylvester Comprehensive Cancer Center
Conducted in-patient consultations,evaluations, as well as provided out-
patient psychotherapy. Performed Bone Marrow Transplant Evaluations, Pain
Evaluations and worked as part of the Kessenich Family ALS, MDA
interdisciplinary team.
2002—2004 Licensed Mental Health Counselor in Private Practice
Provided psychotherapy and crisis intervention to individuals, families and
children. Specialize in mood disorders and ADHD. Services provided in
English and Spanish.
2002-2003 Psychotherapist
Hurwitz Child Crisis Nursery
Provided group and individual counseling to children with a history of abuse
and neglect that had been removed from their homes by DCF.
2001 —2002 Chief Post-Doctoral Psychology Fellow
University of Miami/Jackson Memorial Hospital
Sylvester Comprehensive Cancer Center
Worked as part of an inter-disciplinary team providing consultation and
psychotherapeutic services in English and Spanish to Oncology in-patients
and out-patients. Provided diagnostic and psychotherapeutic services on a
weekly basis to general internal medicine out-patients. The Courtelis Center
also provides services to non-medical patients requesting psychotherapy.
Facilitated monthly relaxation training groups to Oncology patients and their
families. Attended weekly psychiatric grand rounds and participated in in-
patient rounds. Provided an in-service on relaxation training for CEU's. Also
performed administrative duties as Chief Fellow.
2000—2001 Psychotherapist
Citrus Health Network(CHN)
Worked as part of an inter-disciplinary team in the Partial Hospitalization
Program (PHP) and the Outpatient Program. Performed intake interviews,
admissions assessments, psychosocials, formulated treatment plans, and made
appropriate referrals. Provided individual, family, and group therapy as well
as crisis intervention to individuals with a variety of disorders, including
physical health issues. Additionally, worked in the Children's Substance
Abuse Prevention Program(CSAPP) providing intensive therapeutic on site
services including individual and family therapy in the client's homes.
Performed substance abuse psychosocial assessments, formulated treatment
plans, quarterly reviews, CFARS Outcome Measures, ASAMs, SISARs, and
center wide and program discharge summaries as per Medicaid guidelines.
Provided verbal and written progress summaries when necessary to the
Miami-Dade County Court, Substituted for program directors due to vacations
3
for one week in CSAPP, two weeks in the PHP, and two weeks in the
outpatient assessment unit. Also conducted utilization review and provided
certification training on a module of the Iowa Strengthening Families
Program.
1998 — 1999 Psychology Intern
Miami Dade Office of Youth and family Development
Early Intervention Development Center (EIDQ
Worked as part of an inter-disciplinary team serving a population consisting
of severely emotionally disturbed children and their families. Performed
intake interviews, psychosocial assessments, formulated treatment plans and
composed weekly rehab summaries as well as quarterly reviews of client
progress compliant with Medicaid guidelines. Provided updates to the
respective guardian agencies as well as written reports on client progress
when necessary. Psychological assessments were also performed. Provided
individual, marriage, family, and group therapy as well as crisis intervention
and case management.
1998 Research Assistant
University of Miami/Jackson Memorial Hospital
SMART/EST Women's Project
Provided group therapy to a female HIV positive population. Worked as part
of the Cultural Linguistics Working Group back translating assessment
measures. Provided initial recruitment coordination services for the Spanish
portion of the project. Also performed data entry services and participated in
weekly research meetings
1996— 1998 Consultant and Therapist
Greater Miami Adult Day Center
Performed initial assessments, formulated treatment plans, provided
individual counseling, and facilitated groups for patients whose health issues
exacerbated their psychiatric illness. Was also responsible for providing
private individual and family counseling on a self-pay basis under the
supervision of a Licensed Mental Health Counselor.
1995— 1997 Substitute Teacher
Dade County Public School Board
Certified in Psychology, English, and Sociology
1995 Independent Support Coordinator
Choices in Support and Services, Inc.
Provided individual and family therapy, case management, and organized and
formulated support plans and cost plans for a developmentally disabled
population.
1995 Psychotherapist
Parkday Center at Parkway Hospital
Provided group counseling services.
4
1994 Psychotherapist
Various Adult Congregate Living Facilities
Provided group and individual counseling as well as developing and
implementing specific therapeutic interventions.
1994 Psychotherapist
Southern Winds Psychiatric Hospital
Provided group counseling services as part of a multi-disciplinary team.
Developed and implemented a variety of group topics.
PRACTICUM EXPERIENCE
1997 - 1998 Practicum Student
University of Miami/Jackson Memorial Hospital
Provided consultation liaison services to HIV positive individuals and their
families. Also performed neuropsychological testing on pre and post kidney
and heart transplant patients at the Biobehavioral Medicine Division.
Individual counseling was provided on an as needed basis.
1996- 1997 Therapist
Mental Health Association
Provided individual and family counseling, developed treatment plans and
performed psychological testing on a homeless population.
1995 Therapist
Goodman Psychological Services Center
Performed intake assessments, psychosocial, and developed treatment plans.
Provided individual, family, and couples therapy.
1994 Primary Counselor
Juvenile Diversionary Program
Performed intake assessments, psychosocials, and formulated treatment plans.
Provided individual, family and marriage counseling, crisis intervention, and
case management to first tine adolescent offenders and their families.
1994 Therapist
Charter Hospital of Miami
Performed psychosocial assessments, psychosocial addendums, formulated
treatment plans, and facilitated and co-facilitated groups.
Individual therapy was also provided.
5
RESEARCH
1990 - 1991 Research Assistant
University of Miami
Childhood Mobility Project
Performed structured interviews, administered and scored personality tests,
and provided data entry services.
VOLUNTEER WOORK
1998 Volunteer Worker
University of Miami/Jackson Memorial Hospital
Torture Pilot Study
Performed back translation services on assessment measures.
MEMBERSHIPS
2007 - Present Member of the Douglas Gardens Board of Directors
1999—Present American Psychological Association member
1994—Present PsiChi member in good standing(Psychology Honors Society)
LANGUAGES
Fluent in English and Spanish
6