MEDICARE: MENTE SANA PSYCHOLOGICAL SERVICES 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	103TC0700X	Clinical Psychologist	PY7690	FL

General Provider Information

NPI Number	:	1427383629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTE SANA PSYCHOLOGICAL SERVICES INC

Provider Business Mailing Address
First Line	:	3000 CORAL WAY
Second Line	:	515
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3243
Country	:	US
Telephone Number	:	305-772-4513
Fax Number	:	305-454-0156

Provider Business Practice Location Address
First Line	:	3000 CORAL WAY
Second Line	:	515
City	:	CORAL GABLES
State	:	FL
Zip	:	33145-3243
Country	:	US
Telephone Number	:	305-772-4513
Fax Number	:	305-454-0156

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	YAMIR LABOY
Credential	:	PSYD
Telephone Number	:	305-772-4513

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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