Healthcare Provider Details

I. General information

NPI: 1891331559
Provider Name (Legal Business Name): SOUTH FLORIDA HEALTH COLLABORATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 NW 22ND AVE
MIAMI FL
33147-4964
US

IV. Provider business mailing address

5501 SW 97TH AVE
MIAMI FL
33165-7235
US

V. Phone/Fax

Practice location:
  • Phone: 786-346-0877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NOEMI MARQUEZ
Title or Position: DIRECTOR
Credential: LCSW
Phone: 786-346-0877