MEDICARE: AVENTURACOMMUNITYMENTALHEALTHCENTERINC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1598845612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENTURACOMMUNITYMENTALHEALTHCENTERINC

Provider Business Mailing Address
First Line	:	1767 NE 162ND ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4757
Country	:	US
Telephone Number	:	305-940-1011
Fax Number	:	305-940-1012

Provider Business Practice Location Address
First Line	:	1767 NE 162ND ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4757
Country	:	US
Telephone Number	:	305-940-1011
Fax Number	:	305-940-1012

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ELIZABETH BENDER
Credential	:	LMHC
Telephone Number	:	305-940-1011

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	04/09/2008

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