Provider Demographics
NPI:1316362254
Name:BORTNIK, MICHELLE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:BORTNIK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12850 SW 71ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 255
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4721
Practice Address - Country:US
Practice Address - Phone:305-815-2174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3021251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health