MEDICARE: BRIGHTSIDE COMMUNITY MENTAL HEALTH CENTER

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	:	1740360387
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSIDE COMMUNITY MENTAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	1631 SW 32ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-1829
Country	:	US
Telephone Number	:	305-774-1782
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 SW 32ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-1829
Country	:	US
Telephone Number	:	305-774-1782
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL CAMERO
Credential	:
Telephone Number	:	305-774-1782

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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Directions to “BRIGHTSIDE COMMUNITY MENTAL HEALTH CENTER ” Practice Location

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