MEDICARE: PEDIATRIC COUNSELING NETWORK

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1972326833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC COUNSELING NETWORK

Provider Business Mailing Address
First Line	:	416 BELLA VIDA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6716
Country	:	US
Telephone Number	:	407-490-7064
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 BELLA VIDA BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6716
Country	:	US
Telephone Number	:	407-490-4080
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHELIMER MIRO RIVERA
Credential	:	LMHC
Telephone Number	:	407-490-7064

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	11/07/2024

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Directions to “PEDIATRIC COUNSELING NETWORK ” Practice Location

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