MEDICARE: GREEN MIND PSYCHIATRY LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1881537801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN MIND PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	3871 SW 147TH AVE APT 3
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4006
Country	:	US
Telephone Number	:	305-896-6084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3871 SW 147TH AVE APT 3
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4006
Country	:	US
Telephone Number	:	305-896-6084
Fax Number	:

Authorized Official
Title or Position	:	PMHNP
Name	:	ROSBEL PEREZ
Credential	:
Telephone Number	:	305-896-6084

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	06/17/2026

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