MEDICARE: FAMILY MENTAL HEALTH SERVICES OF SOUTH FLORIDA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103T00000X	Psychologist
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1760116966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MENTAL HEALTH SERVICES OF SOUTH FLORIDA, LLC

Provider Business Mailing Address
First Line	:	1701 SUNSET HARBOR DR APT 706
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-1478
Country	:	US
Telephone Number	:	786-252-1665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 SUNSET DR STE 225
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33143-5700
Country	:	US
Telephone Number	:	786-252-1665
Fax Number	:

Authorized Official
Title or Position	:	OWNER - AUTHORIZED OFFICIAL
Name	:	MR. NICHOLAS MACHADO-FEUERMANN
Credential	:	MBA
Telephone Number	:	786-252-1665

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	07/13/2022

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