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General NPI Number Information
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NPI Number | 1518303718
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Entity Type | Organization
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Legal Business Name | MIAMI BRIDGE YOUTH & FAMILY SERVICES, INC.
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 2810 NW SOUTH RIVER DR
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City | MIAMI
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State | FL
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Zip | 33125-1120
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Country | US
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Telephone | 305-635-8953
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Fax | 305-636-3521
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Provider Business Mailing Address
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Address Line | 2810 NW SOUTH RIVER DR
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City | MIAMI
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State | FL
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Zip | 33125-1120
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Country | US
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Telephone | 305-635-8953
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Fax | 305-636-3521
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. MARY J ANDREWS
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Credential | M.S., CRC
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Telephone | 305-636-3520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 100023337
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License Number State | FL
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