MEDICARE: MRS. MELISSA SOSA MIRACOLO MS, 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	103K00000X	Behavior Analyst	MH13464	FL
2	101YM0800X	Mental Health Counselor	MH13464	FL

General Provider Information

NPI Number	:	1356674253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA SOSA MIRACOLO MS, LMHC

Provider Business Mailing Address
First Line	:	125 SW 8TH AVE STE 27B
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33486-4658
Country	:	US
Telephone Number	:	786-218-7382
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 S AUSTRALIAN AVE STE 420
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6447
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:	772-675-9100

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

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	06/16/2020

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