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General NPI Number Information
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NPI Number | 1649623430
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Entity Type | Organization
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Legal Business Name | COTA HEALTH, LLC
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 2950 NE 188TH ST UNIT 333
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City | AVENTURA
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State | FL
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Zip | 33180-2708
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Country | US
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Telephone | 786-707-3428
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Fax |
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Provider Business Mailing Address
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Address Line | 2950 NE 188TH ST UNIT 333
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City | AVENTURA
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State | FL
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Zip | 33180-2708
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Country | US
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Telephone | 786-707-3428
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/ OWNER
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Name | MARISSA C. COTA
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Credential | LCSW
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Telephone | 305-928-9073
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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 | SW12710
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License Number State | FL
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