| Pivotal Therapy, Llc | |
|
3081 Salzedo St Ste 202 Coral Gables FL 33134-6725 | |
| (305) 707-1600 | |
| Not Available |
| Full Name | Pivotal Therapy, Llc |
|---|---|
| Speciality | Counselor |
| Location | 3081 Salzedo St Ste 202, Coral Gables, Florida |
| Authorized Official Name and Position | America Conde (CEO/EXECUTIVE CLINICAL DIRECTOR) |
| Authorized Official Contact | 3057071600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pivotal Therapy, Llc 5810 Sw 14th St West Miami FL 33144-5712 Ph: (305) 878-6913 | Pivotal Therapy, Llc 3081 Salzedo St Ste 202 Coral Gables FL 33134-6725 Ph: (305) 707-1600 |
| NPI Number | 1821603101 |
|---|---|
| Provider Enumeration Date | 09/13/2020 |
| Last Update Date | 12/06/2022 |
| Certification Date | 12/06/2022 |
| Medicare PECOS PAC ID | 1557710001 |
|---|---|
| Medicare Enrollment ID | O20231211000458 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821603101 | NPI | - | NPPES |
| 115187000 | Medicaid | FL | |
| 115186700 | Medicaid | FL | |
| 024870700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | America Conde |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104166396 PECOS PAC ID: 2466801915 Enrollment ID: I20231211000606 |
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