MEDICARE: CLINICAL MIND PSYCHIATRY

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1235072166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL MIND PSYCHIATRY

Provider Business Mailing Address
First Line	:	6919 SW 18TH ST STE C224
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-7010
Country	:	US
Telephone Number	:	561-448-9482
Fax Number	:

Provider Business Practice Location Address
First Line	:	6919 SW 18TH ST STE C224
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-7010
Country	:	US
Telephone Number	:	561-448-9482
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YAIMA ALONSO-JECKELL
Credential	:	MD
Telephone Number	:	786-554-2414

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/17/2026

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