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General NPI Number Information
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NPI Number | 1285177055
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH CARE AND RESOURCE CENTER, INC.
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Dates
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Enumeration Date | 11/28/2016
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 7971 RIVIERA BLVD STE 316
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City | MIRAMAR
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State | FL
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Zip | 33023-6448
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Country | US
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Telephone | 305-570-4064
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Fax | 888-284-6382
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Provider Business Mailing Address
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Address Line | 19821 NW 2ND AVE STE 157
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-3341
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Country | US
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Telephone | 305-494-2798
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Fax | 888-284-6382
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Authorized Official
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Title or Position | CEO
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Name | DELPHINE GERVAIS
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Credential | LCSW
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Telephone | 305-494-2798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | SW 11931
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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