Healthcare Provider Details

I. General information

NPI: 1083066971
Provider Name (Legal Business Name): MASTERPIECE BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 SW 107TH AVE STE 1004
MIAMI FL
33176-1411
US

IV. Provider business mailing address

8835 SW 107TH AVE STE 1044
MIAMI FL
33176-1411
US

V. Phone/Fax

Practice location:
  • Phone: 786-732-0607
  • Fax: 786-732-0637
Mailing address:
  • Phone: 786-732-0607
  • Fax: 786-732-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 10803
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBACB 1-15-21803
License Number StateFL

VIII. Authorized Official

Name: MADIANE PEREZ
Title or Position: MANAGER
Credential: LMHC, BCBA
Phone: 786-732-0607