MEDICARE: INSTITUTE FOR FAMILY THERAPY 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	1041C0700X	Clinical Social Worker	SW1677	FL

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

General Provider Information

NPI Number	:	1407837743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR FAMILY THERAPY INC

Provider Business Mailing Address
First Line	:	6175 NW 153RD ST
Second Line	:	SUITE 404
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2435
Country	:	US
Telephone Number	:	305-558-7400
Fax Number	:	305-558-6134

Provider Business Practice Location Address
First Line	:	6175 NW 153RD ST
Second Line	:	SUITE 404
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2435
Country	:	US
Telephone Number	:	305-558-7400
Fax Number	:	305-558-6134

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. BENJAMIN MIRTENBAUM
Credential	:	MA
Telephone Number	:	305-558-7400

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	01/30/2012

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