Healthcare Provider Details

I. General information

NPI: 1063103505
Provider Name (Legal Business Name): PALAZZO MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12540 SW 8TH ST
MIAMI FL
33184-1412
US

IV. Provider business mailing address

12540 SW 8TH ST
MIAMI FL
33184-1412
US

V. Phone/Fax

Practice location:
  • Phone: 305-705-6840
  • Fax: 786-655-0185
Mailing address:
  • Phone: 305-705-6840
  • Fax: 786-655-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAVELIS MORALES
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-705-6840