MEDICARE: MRS. PERLA SUSANA MUSYKANSKI LMHC

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	MH6143	FL

General Provider Information

NPI Number	:	1851584908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PERLA SUSANA MUSYKANSKI LMHC

Provider Business Mailing Address
First Line	:	1825 NW 167TH ST
Second Line	:	SUITE# 102
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4838
Country	:	US
Telephone Number	:	305-624-7450
Fax Number	:	305-623-7893

Provider Business Practice Location Address
First Line	:	1825 NW 167TH ST
Second Line	:	SUITE# 102
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-4838
Country	:	US
Telephone Number	:	305-624-7450
Fax Number	:	305-623-7893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	12/17/2007

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