MEDICARE: BEHAVIORAL WELLNESS INC.

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

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

General Provider Information

NPI Number	:	1720757313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL WELLNESS INC.

Provider Business Mailing Address
First Line	:	9425 SUNSET DR STE 164
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3290
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9425 SUNSET DR STE 164
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3290
Country	:	US
Telephone Number	:	786-638-4550
Fax Number	:	305-512-8608

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANA LOURDES MARTIN-HIDALGO
Credential	:
Telephone Number	:	305-512-8689

Provider Enumeration Date	:	09/08/2021
Last Update Date	:	09/08/2021

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