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NPI Code Detail

MEDICARE: BERTHA ABESS CHILDREN'S CENTER, INS.

MEDICARE: BERTHA ABESS CHILDREN'S CENTER, INS.
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
11041C0700XClinical Social WorkerSW 6883FL

General Provider Information

NPI Number : 1366574766
Entity Type Code : Organization
Provider Name (Legal Business Name) : BERTHA ABESS CHILDREN'S CENTER, INS.
Provider Business Mailing Address
First Line : 15423 SW 115TH ST
Second Line :
City : MIAMI
State : FL
Zip : 33196-6307
Country : US
Telephone Number : 305-323-7113
Fax Number : 305-386-5772
Provider Business Practice Location Address
First Line : 5801 BISCAYNE BLVD
Second Line :
City : MIAMI
State : FL
Zip : 33137-2638
Country : US
Telephone Number : 305-756-7116
Fax Number :
Authorized Official
Title or Position : CLINICAL SUPERVISOR
Name : DR. LINDA MARTINEZ
Credential : PSY.D.
Telephone Number : 305-756-7116
Provider Enumeration Date : 03/12/2007
Last Update Date : 08/22/2020

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