Provider Demographics
NPI:1467915777
Name:MENTAL HEALTH INSTITUTE OF FLORIDA, LLC.
Entity Type:Organization
Organization Name:MENTAL HEALTH INSTITUTE OF FLORIDA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:FELICIANO
Authorized Official - Last Name:MAMBUCA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-663-8086
Mailing Address - Street 1:1640 NW 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-2656
Mailing Address - Country:US
Mailing Address - Phone:954-251-7005
Mailing Address - Fax:954-251-7005
Practice Address - Street 1:1931 NW 150TH AVE STE 111-112
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2877
Practice Address - Country:US
Practice Address - Phone:954-251-7005
Practice Address - Fax:954-251-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty