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General NPI Number Information
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NPI Number | 1043991748
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Entity Type | Organization
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Legal Business Name | SERPICO HEALING LLC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 105 NE 12TH AVE APT 19
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4567
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Country | US
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Telephone | 305-619-2004
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Fax |
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Provider Business Mailing Address
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Address Line | 105 NE 12TH AVE APT 19
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4567
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Country | US
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Telephone | 305-619-2004
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JOHN SERPICO
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Credential | LMHC
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Telephone | 305-619-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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