MEDICARE: ROBERTO CEPEDA BSW

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

General Provider Information

NPI Number	:	1598715385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO CEPEDA BSW

Provider Business Mailing Address
First Line	:	11031 NE 6TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-7182
Country	:	US
Telephone Number	:	305-398-6100
Fax Number	:	305-757-4465

Provider Business Practice Location Address
First Line	:	3830 W FLAGLER ST
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1604
Country	:	US
Telephone Number	:	305-774-3616
Fax Number	:	305-476-2640

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	04/01/2009

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