Provider Demographics
NPI:1487674800
Name:ST THERESA COMMUNITY MENTAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:ST THERESA COMMUNITY MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-825-8110
Mailing Address - Street 1:7000 W 12TH AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5154
Mailing Address - Country:US
Mailing Address - Phone:305-825-8110
Mailing Address - Fax:305-825-8185
Practice Address - Street 1:7000 W 12TH AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5154
Practice Address - Country:US
Practice Address - Phone:305-825-8110
Practice Address - Fax:305-825-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101468Medicare Oscar/Certification