Healthcare Provider Details

I. General information

NPI: 1306410782
Provider Name (Legal Business Name): KOKORO CARE NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 OKEECHOBEE BLVD STE 4
WEST PALM BEACH, FL FL
33411
US

IV. Provider business mailing address

605 BELVEDERE RD STE 7
WEST PALM BEACH FL
33405-1216
US

V. Phone/Fax

Practice location:
  • Phone: 786-547-3170
  • Fax:
Mailing address:
  • Phone: 561-560-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SACHIE TAMAYO
Title or Position: CEO
Credential: M.S., BCBA
Phone: 786-547-3170