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General NPI Number Information
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NPI Number | 1639790082
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Entity Type | Organization
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Legal Business Name | CHILDREN'S WELLNESS
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 10689 N KENDALL DR STE 215
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City | MIAMI
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State | FL
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Zip | 33176-1594
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Country | US
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Telephone | 305-310-4245
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 144701
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City | CORAL GABLES
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State | FL
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Zip | 33114-4701
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Country | US
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Telephone | 305-310-4245
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MERCEDES CARBALLO
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Credential | LMHC
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Telephone | 305-310-4245
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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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