Healthcare Provider Details

I. General information

NPI: 1699167403
Provider Name (Legal Business Name): MENTAL HEALTH INSTITUTE OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 NW 150TH AVE STE 104
PEMBROKE PINES FL
33028-2872
US

IV. Provider business mailing address

3311 SW 195TH TER
MIRAMAR FL
33029-5881
US

V. Phone/Fax

Practice location:
  • Phone: 786-393-0361
  • Fax: 954-251-7005
Mailing address:
  • Phone: 954-663-8086
  • Fax: 954-251-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH11089
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberMH11089
License Number StateFL

VIII. Authorized Official

Name: DR. ANDRES FELICIANO MAMBUCA
Title or Position: CLINICAL DIRECTOR
Credential: PSYD, MS, LMHC, BCBA
Phone: 954-663-8086