MEDICARE: MICHAL KESHEN M.A., MS.ED., LMFT

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	174400000X	Specialist	MT1920	FL

General Provider Information

NPI Number	:	1194931758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAL KESHEN M.A., MS.ED., LMFT

Provider Business Mailing Address
First Line	:	5825 SUNSET DR
Second Line	:	SUITE 301
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5222
Country	:	US
Telephone Number	:	305-275-2056
Fax Number	:	305-670-6203

Provider Business Practice Location Address
First Line	:	5825 SUNSET DR
Second Line	:	SUITE 301
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-5222
Country	:	US
Telephone Number	:	305-275-2056
Fax Number	:	305-670-6203

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	10/29/2009

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