Healthcare Provider Details

I. General information

NPI: 1083872295
Provider Name (Legal Business Name): MADIANE PEREZ LMHC, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8835 SW 107TH AVE STE 1044
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 NumberMH10803
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-21083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: