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General NPI Number Information
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NPI Number | 1508263492
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Entity Type | Individual
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Provider Name | DEBORA BORTNIK LMHC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 9075 SW 87TH AVE SUITE 412
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City | MIAMI
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State | FL
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Zip | 33176-2308
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Country | US
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Telephone | 305-815-2787
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Fax |
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Provider Business Mailing Address
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Address Line | 12850 SW 71ST AVE
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City | MIAMI
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State | FL
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Zip | 33156-6273
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Country | US
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Telephone | 305-297-1472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MH12969
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License Number State | FL
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