MEDICARE: MR. SERGIO BALCAZAR JR. L.M.F.T.

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	106H00000X	Marriage & Family Therapist	MT2634	FL

General Provider Information

NPI Number	:	1093089625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SERGIO BALCAZAR JR. L.M.F.T.

Provider Business Mailing Address
First Line	:	2700 W CYPRESS CREEK RD
Second Line	:	D104
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1744
Country	:	US
Telephone Number	:	954-514-7569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 W CYPRESS CREEK RD
Second Line	:	D104
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1744
Country	:	US
Telephone Number	:	954-514-7569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	02/29/2012

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