MEDICARE: BEAUTIFUL MIND BEHAVIORAL 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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528677283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL MIND BEHAVIORAL LLC

Provider Business Mailing Address
First Line	:	7271 SW 13TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-5305
Country	:	US
Telephone Number	:	786-212-4566
Fax Number	:

Provider Business Practice Location Address
First Line	:	7271 SW 13TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-5305
Country	:	US
Telephone Number	:	786-212-4566
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHANNA NICASIO
Credential	:
Telephone Number	:	786-212-4566

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	09/23/2024

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