Healthcare Provider Details

I. General information

NPI: 1316362247
Provider Name (Legal Business Name): MINDY S. HERSH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2014
Last Update Date: 03/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 SW 104TH ST SUITE 100
MIAMI FL
33156-3161
US

IV. Provider business mailing address

13724 SW 104TH CT
MIAMI FL
33176-6679
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-8000
  • Fax:
Mailing address:
  • Phone: 305-254-2951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH1423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: