Provider Demographics
NPI:1336477819
Name:MANUEL CERDA LCSW CORP
Entity Type:Organization
Organization Name:MANUEL CERDA LCSW CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:CERDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-490-2009
Mailing Address - Street 1:9107 SW 151ST AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1313
Mailing Address - Country:US
Mailing Address - Phone:305-490-2009
Mailing Address - Fax:305-385-1816
Practice Address - Street 1:9107 SW 151ST AVENUE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1313
Practice Address - Country:US
Practice Address - Phone:305-490-2009
Practice Address - Fax:305-385-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00045111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7740Medicare PIN