MEDICARE: AJM BEHAVIOR WELLNESS CENTER, CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1013742717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJM BEHAVIOR WELLNESS CENTER, CO

Provider Business Mailing Address
First Line	:	306 ALCAZAR AVE STE 200
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4318
Country	:	US
Telephone Number	:	305-967-8725
Fax Number	:	305-967-8446

Provider Business Practice Location Address
First Line	:	306 ALCAZAR AVE STE 200
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4318
Country	:	US
Telephone Number	:	305-967-8725
Fax Number	:	305-967-8446

Authorized Official
Title or Position	:	CHIEF STAFF
Name	:	MARIETA MANRESA
Credential	:	PHD
Telephone Number	:	786-354-3505

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/04/2024

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