Healthcare Provider Details

I. General information

NPI: 1245987395
Provider Name (Legal Business Name): M.A.M. THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20535 NW 2ND AVE STE 210
MIAMI FL
33169-2547
US

IV. Provider business mailing address

20535 NW 2ND AVE STE 210
MIAMI FL
33169-2547
US

V. Phone/Fax

Practice location:
  • Phone: 305-934-4382
  • Fax:
Mailing address:
  • Phone: 305-934-4382
  • Fax: 305-934-4382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELIDA BERROA
Title or Position: CEO
Credential: LCSW
Phone: 305-934-4382