Healthcare Provider Details

I. General information

NPI: 1821590837
Provider Name (Legal Business Name): ANDREA PUECH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 SW 74TH CT
MIAMI FL
33155-4483
US

IV. Provider business mailing address

11401 SW 68TH CT
MIAMI FL
33156-4717
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-0013
  • Fax:
Mailing address:
  • Phone: 786-300-7798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: