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General NPI Number Information
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NPI Number | 1285306159
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Entity Type | Organization
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Legal Business Name | THE MENTAL MOVEMENT LLC.
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 12760 SW 229TH TER
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City | MIAMI
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State | FL
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Zip | 33170-2755
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Country | US
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Telephone | 786-212-0289
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Fax |
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Provider Business Mailing Address
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Address Line | 18591 S DIXIE HWY # 1039
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City | CUTLER BAY
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State | FL
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Zip | 33157-6845
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Country | US
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Telephone | 786-212-0289
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | KALA M BROWN
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Credential | LCSW
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Telephone | 786-212-0289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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