Provider Demographics
NPI:1164914172
Name:BEHAVIORAL MOMENTUM OF MIAMI
Entity Type:Organization
Organization Name:BEHAVIORAL MOMENTUM OF MIAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYKEL
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:786-390-1855
Mailing Address - Street 1:10561 SW 122ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3632
Mailing Address - Country:US
Mailing Address - Phone:305-775-2489
Mailing Address - Fax:
Practice Address - Street 1:10561 SW 122ND CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3632
Practice Address - Country:US
Practice Address - Phone:305-775-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-05
Last Update Date:2021-10-21
Deactivation Date:2021-08-27
Deactivation Code:
Reactivation Date:2021-10-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty