Provider Demographics
NPI:1346868106
Name:CDM BEHAVIORAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:CDM BEHAVIORAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAINERIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALERA RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-804-4708
Mailing Address - Street 1:1250 W 53RD ST APT 18
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3086
Mailing Address - Country:US
Mailing Address - Phone:305-804-4708
Mailing Address - Fax:
Practice Address - Street 1:1250 W 53RD ST APT 18
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3086
Practice Address - Country:US
Practice Address - Phone:305-804-4708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2004201983Medicaid