MEDICARE: EMBRACE MENTAL HEALTH LLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1467295253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACE MENTAL HEALTH LLC

Provider Business Mailing Address
First Line	:	200 S ANDREWS AVE STE 504
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2066
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S ANDREWS AVE STE 504
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2066
Country	:	US
Telephone Number	:	545-805-0199
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VERLANDE DORILAS
Credential	:	PMHNP
Telephone Number	:	954-560-0653

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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