MEDICARE: MILLENNIUM COMMUNITY MENTAL HEALTH CENTER 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	:	1366579500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM COMMUNITY MENTAL HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	2955 SW 8TH ST
Second Line	:	202
City	:	MIAMI
State	:	FL
Zip	:	33135-2862
Country	:	US
Telephone Number	:	305-631-9400
Fax Number	:	305-631-9455

Provider Business Practice Location Address
First Line	:	2955 SW 8TH ST
Second Line	:	202
City	:	MIAMI
State	:	FL
Zip	:	33135-2862
Country	:	US
Telephone Number	:	305-631-9400
Fax Number	:	305-631-9455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA E OTERO
Credential	:	LMHC
Telephone Number	:	305-631-9400

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	05/22/2009

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