MEDICARE: MRS. ANDREA HENAO

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1811211725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA HENAO

Provider Business Mailing Address
First Line	:	15051 ROYAL OAKS LN APT 2503
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2462
Country	:	US
Telephone Number	:	786-327-4395
Fax Number	:

Provider Business Practice Location Address
First Line	:	15051 ROYAL OAKS LN APT 2503
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2462
Country	:	US
Telephone Number	:	786-327-4395
Fax Number	:

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

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	03/22/2010

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