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NPI Code Detail

MEDICARE: ADVANCED MENTAL HEALTH CLINIC INC

MEDICARE: ADVANCED MENTAL HEALTH CLINIC 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
1103K00000XBehavior Analyst
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)101490FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EO918AOTHERFLMEDICARE PART B

Other Identifiers

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

General Provider Information

NPI Number : 1285676494
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED MENTAL HEALTH CLINIC INC
Provider Business Mailing Address
First Line : 13055 SW 42ND ST STE 104
Second Line :
City : MIAMI
State : FL
Zip : 33175-3470
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13055 SW 42ND ST STE 104
Second Line :
City : MIAMI
State : FL
Zip : 33175-3470
Country : US
Telephone Number : 305-480-7839
Fax Number : 305-480-7892
Authorized Official
Title or Position : PRESIDENT/ADMINISTRATOR
Name : MS. LUCIA CARRENO
Credential :
Telephone Number : 305-480-7839
Provider Enumeration Date : 06/12/2006
Last Update Date : 09/01/2020

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