=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083124200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE FOR A BRIGHTER DAY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2017
-----------------------------------------------------
Last Update Date | 01/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14355 SW 120TH ST STE 105
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-7093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-444-4205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14355 SW 120TH ST STE 105
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33186-7093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-444-4205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | DR. MATILDE ZAYAS
-----------------------------------------------------
Credential | PHD, CHT
-----------------------------------------------------
Telephone | 305-383-6336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | IHM5221
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | IHM5221
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------