MEDICARE: BLUE OCEAN MINDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst
3	251B00000X	Case Management Agency
4	251S00000X	Community/Behavioral Health Agency
5	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1366901456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE OCEAN MINDS, LLC

Provider Business Mailing Address
First Line	:	257 SW 7TH ST
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-3947
Country	:	US
Telephone Number	:	305-606-3882
Fax Number	:

Provider Business Practice Location Address
First Line	:	257 SW 7TH ST
Second Line	:
City	:	DANIA BEACH
State	:	FL
Zip	:	33004-3947
Country	:	US
Telephone Number	:	305-606-3882
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. YENSY ACOSTA
Credential	:	LCSW
Telephone Number	:	305-606-3882

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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Directions to “BLUE OCEAN MINDS, LLC ” Practice Location

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