=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902465339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENDALL BEHAVIORAL MENTAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2019
-----------------------------------------------------
Last Update Date | 06/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10621 N KENDALL DR STE 122
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-402-8282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10621 N KENDALL DR STE 122
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-402-8282
-----------------------------------------------------
Fax | 786-419-0756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VISEPRESIDENT
-----------------------------------------------------
Name | MS. ARELYS ZERPA
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 786-338-8999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------