Healthcare Provider Details

I. General information

NPI: 1922708668
Provider Name (Legal Business Name): TARGETED CASE MANAGEMENT OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 NW 151ST ST STE 127
MIAMI LAKES FL
33014-2442
US

IV. Provider business mailing address

5881 NW 151ST ST STE 127
MIAMI LAKES FL
33014-2442
US

V. Phone/Fax

Practice location:
  • Phone: 786-905-2262
  • Fax: 786-398-5500
Mailing address:
  • Phone: 786-905-2262
  • Fax: 786-398-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NOEL FIALLO
Title or Position: CEO
Credential:
Phone: 786-905-2262