MEDICARE: BERMUDEZ BEHAVIORAL AND MENTAL HEALTH SERVICES INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1316304488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERMUDEZ BEHAVIORAL AND MENTAL HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	3442 WILSHIRE WAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3442 WILSHIRE WAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7354
Country	:	US
Telephone Number	:	305-767-8223
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	ANGEL ADRIAN PEREZ BERMUDEZ
Credential	:	MHS
Telephone Number	:	305-767-8223

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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