Healthcare Provider Details

I. General information

NPI: 1821786880
Provider Name (Legal Business Name): JOSEPH ALEXANDER KANOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NW 165TH STREET RD
MIAMI FL
33169-6306
US

IV. Provider business mailing address

500 NW 165TH STREET RD
MIAMI FL
33169-6306
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-2272
  • Fax: 786-657-2371
Mailing address:
  • Phone: 786-657-2272
  • Fax: 786-657-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: