=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457522484
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CESAR B INCERA M.PSY., L.M.H.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2008
-----------------------------------------------------
Last Update Date | 03/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 SW 88TH ST SUITE 415
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-670-0204
-----------------------------------------------------
Fax | 305-670-9973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7400 SW 88TH ST SUITE 415
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-7706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-670-0204
-----------------------------------------------------
Fax | 305-670-9973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH2196
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------