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4302 Hollywood Blvd #177 Hollywood FL 33021-6635 | |
| (786) 274-3549 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4302 Hollywood Blvd, Hollywood, Florida |
| Authorized Official Name and Position | Maria T Puentes (PROGRAM DIRECTOR) |
| Authorized Official Contact | 7862743549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4302 Hollywood Boulevard #177 Hollywood FL 33021 Ph: (786) 274-3549 | 4302 Hollywood Blvd #177 Hollywood FL 33021-6635 Ph: (786) 274-3549 |
| NPI Number | 1962948323 |
|---|---|
| Provider Enumeration Date | 01/10/2017 |
| Last Update Date | 05/11/2021 |
| Certification Date | 05/11/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962948323 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | MH13032 (Florida) | Primary |
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