Provider Demographics
NPI:1083066971
Name:MASTERPIECE BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:MASTERPIECE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, BCBA
Authorized Official - Phone:305-244-5085
Mailing Address - Street 1:12150 SW 128TH CT STE 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4648
Mailing Address - Country:US
Mailing Address - Phone:786-732-0607
Mailing Address - Fax:786-732-0637
Practice Address - Street 1:12150 SW 128TH CT STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4648
Practice Address - Country:US
Practice Address - Phone:786-732-0607
Practice Address - Fax:786-732-0637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 10803101YM0800X
FLBACB 1-15-21803251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003762900Medicaid