Healthcare Provider Details

I. General information

NPI: 1013406271
Provider Name (Legal Business Name): MOUNT SINAI MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 660
MIAMI BEACH FL
33140-2877
US

IV. Provider business mailing address

4306 ALTON RD FL 2
MIAMI BEACH FL
33140-2840
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2876
  • Fax: 305-674-2916
Mailing address:
  • Phone: 305-535-3349
  • Fax: 305-535-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE CHUTKAN
Title or Position: SENIOR VP OF FINANCE
Credential: AUTHORIZED OFFICIAL
Phone: 305-674-2121