MEDICARE: MISS MICHELLE BORTNIK LMFT

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	251S00000X	Community/Behavioral Health Agency	MT3021	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1316362254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE BORTNIK LMFT

Provider Business Mailing Address
First Line	:	12850 SW 71ST AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-6273
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 NE MIAMI GARDENS DR STE 255
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-4721
Country	:	US
Telephone Number	:	305-815-2174
Fax Number	:

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

Provider Enumeration Date	:	03/02/2014
Last Update Date	:	04/05/2024

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Directions to “ MISS MICHELLE BORTNIK LMFT” Practice Location

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