MEDICARE: MISHELLE ORTIZ-VELEZ LMFT

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	106H00000X	Marriage & Family Therapist	MT3026	FL

General Provider Information

NPI Number	:	1871955294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISHELLE ORTIZ-VELEZ LMFT

Provider Business Mailing Address
First Line	:	1040 BAYVIEW DR
Second Line	:	SUITE 110
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2522
Country	:	US
Telephone Number	:	954-800-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 BAYVIEW DR
Second Line	:	SUITE 110
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2522
Country	:	US
Telephone Number	:	954-800-0818
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	03/24/2016

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