MEDICARE: CARLOS MACEDO 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	101YM0800X	Mental Health Counselor	MH13726	FL

General Provider Information

NPI Number	:	1396118352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS MACEDO LMHC

Provider Business Mailing Address
First Line	:	5708 CODY ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2139
Country	:	US
Telephone Number	:	954-558-8138
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 SE 18TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2812
Country	:	US
Telephone Number	:	954-558-8138
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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Directions to “ CARLOS MACEDO LMHC” Practice Location

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