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NPI Code Detail

MEDICARE: VIDA COUNSELING GROUP, LLC

MEDICARE: VIDA COUNSELING GROUP, 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
11041C0700XClinical Social Worker11235FL
2106H00000XMarriage & Family Therapist2657FL
3171M00000XCase Manager/Care Coordinator
4251B00000XCase Management Agency
5103K00000XBehavior Analyst

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 : 1275968372
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIDA COUNSELING GROUP, LLC
Provider Business Mailing Address
First Line : 5455 SW 8TH ST STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-2290
Country : US
Telephone Number : 786-629-8836
Fax Number : 888-241-5711
Provider Business Practice Location Address
First Line : 5455 SW 8TH ST STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-2290
Country : US
Telephone Number : 786-629-8836
Fax Number : 888-241-5711
Authorized Official
Title or Position : VICE-PRESIDENT
Name : MRS. GRISEL CARTAS
Credential : LCSW, BCBA
Telephone Number : 305-397-5013
Provider Enumeration Date : 09/08/2013
Last Update Date : 12/03/2024

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842 SALZEDO ST APT B
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