Healthcare Provider Details

I. General information

NPI: 1881537801
Provider Name (Legal Business Name): GREEN MIND PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 SW 147TH AVE APT 3
MIAMI FL
33185-4006
US

IV. Provider business mailing address

3871 SW 147TH AVE APT 3
MIAMI FL
33185-4006
US

V. Phone/Fax

Practice location:
  • Phone: 305-896-6084
  • Fax:
Mailing address:
  • Phone: 305-896-6084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ROSBEL PEREZ
Title or Position: PMHNP
Credential:
Phone: 305-896-6084