MEDICARE: MANAGED MENTAL HEALTH LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033716055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANAGED MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	4445 W 16TH AVE STE 411
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 W 16TH AVE STE 411
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-7191
Country	:	US
Telephone Number	:	305-764-6417
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALBERTO LAMADRID
Credential	:
Telephone Number	:	305-764-6417

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	05/23/2022

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