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NPI Code Detail

MEDICARE: MICHELLE AVILA LCSW

MEDICARE: MICHELLE AVILA LCSW
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
11041C0700XClinical Social WorkerSW9487FL

Other Identifiers

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

General Provider Information

NPI Number : 1194956409
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE AVILA LCSW
Provider Business Mailing Address
First Line : 8100 GENEVA CT # C543
Second Line :
City : DORAL
State : FL
Zip : 33166-4697
Country : US
Telephone Number : 305-718-9504
Fax Number :
Provider Business Practice Location Address
First Line : 4175 W 20TH AVE
Second Line :
City : HIALEAH
State : FL
Zip : 33012-5874
Country : US
Telephone Number : 305-825-0300
Fax Number : 305-424-3184
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2009
Last Update Date : 08/04/2009

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Directions to “ MICHELLE AVILA LCSW” Practice Location

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