MEDICARE: MHA WELLNESS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1053991059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MHA WELLNESS LLC

Provider Business Mailing Address
First Line	:	4801 LINTON BLVD STE 11A
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6582
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SW 12TH AVE STE 106
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-3114
Country	:	US
Telephone Number	:	561-703-9893
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SABRINA BENNARDO
Credential	:	LCSW
Telephone Number	:	561-703-9893

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	04/13/2021

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Directions to “MHA WELLNESS LLC ” Practice Location

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