MEDICARE: CONNECTING WATERS COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811740905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTING WATERS COUNSELING LLC

Provider Business Mailing Address
First Line	:	220 SW 4TH AVE
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5433
Country	:	US
Telephone Number	:	954-740-3452
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 SW 4TH AVE
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-5433
Country	:	US
Telephone Number	:	954-740-3452
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BEATRICE FERNANDEZ
Credential	:
Telephone Number	:	954-740-3452

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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