| Community Behavioral Health Llc | |
|
3501 Del Prado Blvd S Ste 303 Cape Coral FL 33904-7222 | |
| (239) 317-0265 | |
| (239) 673-7681 |
| Full Name | Community Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3501 Del Prado Blvd S Ste 303, Cape Coral, Florida |
| Authorized Official Name and Position | Miguel A Diaz (OWNER) |
| Authorized Official Contact | 2394643310 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Behavioral Health Llc 3501 Del Prado Blvd S Ste 303 Cape Coral FL 33904-7222 Ph: (239) 424-3346 | Community Behavioral Health Llc 3501 Del Prado Blvd S Ste 303 Cape Coral FL 33904-7222 Ph: (239) 317-0265 |
| NPI Number | 1649733544 |
|---|---|
| Provider Enumeration Date | 04/09/2019 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/25/2024 |
| Medicare PECOS PAC ID | 6204164882 |
|---|---|
| Medicare Enrollment ID | O20190820003457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649733544 | NPI | - | NPPES |
| 103311900 | Medicaid | FL | |
| 103311901 | Medicaid | FL | |
| 3FBY8 | Other | FL | BLUE CROSS |
| Provider Name | Carol J Carter Schofield |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417052853 PECOS PAC ID: 0840486171 Enrollment ID: I20101129000101 |
| Provider Name | Mizyl Frances Damayo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518057264 PECOS PAC ID: 3072614452 Enrollment ID: I20121113000270 |
| Provider Name | Gabriel Rivera Torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043727563 PECOS PAC ID: 4183986565 Enrollment ID: I20180322002735 |
| Provider Name | Miguel A Diaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629511290 PECOS PAC ID: 7012920143 Enrollment ID: I20180521003035 |
| Provider Name | Annet T Lister Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164040259 PECOS PAC ID: 5799104105 Enrollment ID: I20201005002200 |
| Provider Name | Juan C Ponce |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639848419 PECOS PAC ID: 4688063670 Enrollment ID: I20211112001285 |
| Provider Name | Yanysel Gonzalez Torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538824727 PECOS PAC ID: 2264824556 Enrollment ID: I20220118002446 |
| Provider Name | Barbaro Raimis Sarosa Cepero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477086544 PECOS PAC ID: 0941460455 Enrollment ID: I20220405002802 |
| Provider Name | Yamile Castaneira |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508582339 PECOS PAC ID: 6002282662 Enrollment ID: I20221021002683 |
| Provider Name | Diana Acosta Romero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003518499 PECOS PAC ID: 6800261371 Enrollment ID: I20230414001132 |
| Provider Name | Marcheley Adam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508003369 PECOS PAC ID: 6507221694 Enrollment ID: I20230425000244 |
| Provider Name | Hedrick Frank |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669866521 PECOS PAC ID: 2466802467 Enrollment ID: I20240102004113 |
| Provider Name | Chemenda Sawyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1942604863 PECOS PAC ID: 2860843570 Enrollment ID: I20240108000475 |
| Provider Name | Liana Calderin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174183537 PECOS PAC ID: 0143671792 Enrollment ID: I20240108004050 |
| Provider Name | Jessica Rae Brooks |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154992873 PECOS PAC ID: 2769833300 Enrollment ID: I20240109001112 |
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