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NPI Code Detail

MEDICARE: JULIE M BASULTO M.S., LMFT

MEDICARE: JULIE M BASULTO M.S., LMFT
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
1106H00000XMarriage & Family TherapistMT 2348FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518295468
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE M BASULTO M.S., LMFT
Provider Business Mailing Address
First Line : 18441 NW 2ND AVE
Second Line : SUITE 500
City : MIAMI GARDENS
State : FL
Zip : 33169-4517
Country : US
Telephone Number : 305-249-0521
Fax Number : 305-249-0523
Provider Business Practice Location Address
First Line : 18441 NW 2ND AVE
Second Line : SUITE 500
City : MIAMI GARDENS
State : FL
Zip : 33169-4517
Country : US
Telephone Number : 305-249-0521
Fax Number : 305-249-0523
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2009
Last Update Date : 12/03/2009

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