MEDICARE: MIND PROFESSIONAL MANAGEMENT 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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1780306696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIND PROFESSIONAL MANAGEMENT INC

Provider Business Mailing Address
First Line	:	1024 SW 142ND PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33184-3075
Country	:	US
Telephone Number	:	305-498-9776
Fax Number	:	786-235-1074

Provider Business Practice Location Address
First Line	:	2103 CORAL WAY STE 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2630
Country	:	US
Telephone Number	:	305-445-9554
Fax Number	:	786-235-1074

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ADRIANA D VILCHES
Credential	:
Telephone Number	:	305-445-9554

Provider Enumeration Date	:	09/16/2022
Last Update Date	:	09/16/2022

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