MEDICARE: SAM KEDEM LMHC

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	101YM0800X	Mental Health Counselor	MH 7751	FL

General Provider Information

NPI Number	:	1306115654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM KEDEM LMHC

Provider Business Mailing Address
First Line	:	3601 FEDERAL HWY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-3795
Country	:	US
Telephone Number	:	305-576-6611
Fax Number	:	305-994-1516

Provider Business Practice Location Address
First Line	:	100 NE 38TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-3654
Country	:	US
Telephone Number	:	305-576-6611
Fax Number	:	305-994-1516

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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