Healthcare Provider Details

I. General information

NPI: 1386221380
Provider Name (Legal Business Name): ULYSSES ARTEAGA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3778 W 12TH AVE
HIALEAH FL
33012-4126
US

IV. Provider business mailing address

3778 W 12TH AVE
HIALEAH FL
33012-4126
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-6414
  • Fax:
Mailing address:
  • Phone: 786-953-6414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW4200
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: