Healthcare Provider Details

I. General information

NPI: 1699573956
Provider Name (Legal Business Name): FLORIDIAN SOCIAL SERVICES AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14791 OAK LN STE B
MIAMI LAKES FL
33016-1518
US

IV. Provider business mailing address

14791 OAK LN STE B
MIAMI LAKES FL
33016-1518
US

V. Phone/Fax

Practice location:
  • Phone: 305-570-0025
  • Fax:
Mailing address:
  • Phone: 305-570-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTOLIN BENITEZ
Title or Position: OWNER
Credential:
Phone: 305-570-0025