Provider Demographics
NPI:1104366160
Name:MIAMI PERSONAL BEHAVIORAL LLC
Entity Type:Organization
Organization Name:MIAMI PERSONAL BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-4025
Mailing Address - Street 1:3611 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3636
Mailing Address - Country:US
Mailing Address - Phone:305-223-2618
Mailing Address - Fax:
Practice Address - Street 1:3611 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3636
Practice Address - Country:US
Practice Address - Phone:305-223-2618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003156900Medicaid