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General NPI Number Information
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NPI Number | 1770762676
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Entity Type | Organization
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Legal Business Name | NEW LIFE MENTAL HEALTH CENTER
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 6700 GRIFFIN RD SUITE J
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City | DAVIE
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State | FL
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Zip | 33314-4300
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Country | US
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Telephone | 954-321-3977
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Fax | 954-321-3947
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Provider Business Mailing Address
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Address Line | 6700 GRIFFIN RD SUITE J
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City | DAVIE
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State | FL
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Zip | 33314-4300
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Country | US
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Telephone | 954-321-3977
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Fax | 954-321-3947
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIELA OTERO
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Credential |
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Telephone | 954-321-3977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | HCC7878
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License Number State | FL
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