Healthcare Provider Details

I. General information

NPI: 1720726235
Provider Name (Legal Business Name): HEARTLOGIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16782 SW 88TH ST # 344
MIAMI FL
33196-5934
US

IV. Provider business mailing address

16782 SW 88TH ST # 344
MIAMI FL
33196-5934
US

V. Phone/Fax

Practice location:
  • Phone: 802-557-1065
  • Fax:
Mailing address:
  • Phone: 802-557-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANA BULNES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSW, LCSW, LICSW
Phone: 802-557-1065