Healthcare Provider Details

I. General information

NPI: 1346868106
Provider Name (Legal Business Name): CDM BEHAVIORAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W 53RD ST APT 18
HIALEAH FL
33012-3086
US

IV. Provider business mailing address

1250 W 53RD ST APT 18
HIALEAH FL
33012-3086
US

V. Phone/Fax

Practice location:
  • Phone: 305-804-4708
  • Fax:
Mailing address:
  • Phone: 305-804-4708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DAINERIS VALERA RIVERO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 305-804-4708