MEDICARE: DENISE ALEXANDRA CENTENO

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

General Provider Information

NPI Number	:	1740941947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE ALEXANDRA CENTENO

Provider Business Mailing Address
First Line	:	13281 SW 127TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-6361
Country	:	US
Telephone Number	:	786-394-3275
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 NW 68TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1232
Country	:	US
Telephone Number	:	305-310-3015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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