Healthcare Provider Details

I. General information

NPI: 1902676323
Provider Name (Legal Business Name): MSC BEHAVIORAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 NW 98TH CT
MIAMI FL
33172-4036
US

IV. Provider business mailing address

477 NW 98TH CT
MIAMI FL
33172-4036
US

V. Phone/Fax

Practice location:
  • Phone: 786-675-0420
  • Fax:
Mailing address:
  • Phone: 786-675-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MERCEDES SANCHEZ CAMPANO
Title or Position: OWNER
Credential:
Phone: 786-675-0420