Healthcare Provider Details

I. General information

NPI: 1689299703
Provider Name (Legal Business Name): MIAMI BEACH BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 WASHINGTON AVE STE 221
MIAMI BEACH FL
33139-4203
US

IV. Provider business mailing address

1354 WASHINGTON AVE STE 221
MIAMI BEACH FL
33139-4203
US

V. Phone/Fax

Practice location:
  • Phone: 305-766-8064
  • Fax: 305-899-5165
Mailing address:
  • Phone: 305-766-8064
  • Fax: 305-899-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: OLGA CCASTRO
Title or Position: OWNER
Credential:
Phone: 305-766-8064