MEDICARE: INCERA MENTAL WELLNESS CENTER LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1912854001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCERA MENTAL WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	404 NE 10TH AVE STE A
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3295
Country	:	US
Telephone Number	:	305-775-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 NE 10TH AVE STE A
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-3295
Country	:	US
Telephone Number	:	305-775-8516
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARIBEL FERNANDEZ
Credential	:
Telephone Number	:	954-709-7502

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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