Provider Demographics
NPI:1073001947
Name:MENTAL HEALTHNETWORK , INC
Entity Type:Organization
Organization Name:MENTAL HEALTHNETWORK , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDERRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-255-7979
Mailing Address - Street 1:124 SE 1ST RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7357
Mailing Address - Country:US
Mailing Address - Phone:786-255-7979
Mailing Address - Fax:786-258-9772
Practice Address - Street 1:124 SE 1ST RD UNIT A
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7357
Practice Address - Country:US
Practice Address - Phone:786-255-7979
Practice Address - Fax:786-258-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105045200Medicaid