MEDICARE: BREAKTHROUGH CARE AND RESOURCE CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist
3	305S00000X	Point of Service	SW 11931	FL
4	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285177055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAKTHROUGH CARE AND RESOURCE CENTER, INC.

Provider Business Mailing Address
First Line	:	19821 NW 2ND AVE STE 157
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33169-3341
Country	:	US
Telephone Number	:	305-494-2798
Fax Number	:	888-284-6382

Provider Business Practice Location Address
First Line	:	7971 RIVIERA BLVD STE 316
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-6448
Country	:	US
Telephone Number	:	305-570-4064
Fax Number	:	888-284-6382

Authorized Official
Title or Position	:	CEO
Name	:	DELPHINE GERVAIS
Credential	:	LCSW
Telephone Number	:	305-494-2798

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	12/27/2021

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