MEDICARE: BALANCED PSYCH., CORP

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	103K00000X	Behavior Analyst
2	101YM0800X	Mental Health Counselor	MH9609	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679013650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALANCED PSYCH., CORP

Provider Business Mailing Address
First Line	:	13901 SW 152ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-5017
Country	:	US
Telephone Number	:	786-261-5924
Fax Number	:

Provider Business Practice Location Address
First Line	:	13901 SW 152ND CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-5017
Country	:	US
Telephone Number	:	786-261-5924
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLAUDIA RUIZ-MATAMOROS
Credential	:	LMHC
Telephone Number	:	786-261-5924

Provider Enumeration Date	:	02/24/2017
Last Update Date	:	02/24/2017

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Directions to “BALANCED PSYCH., CORP ” Practice Location

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