Provider Demographics
NPI:1508200114
Name:TAVERAS, ADAM (MFT MT 3614)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:TAVERAS
Suffix:
Gender:M
Credentials:MFT MT 3614
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 SW 83RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1111
Mailing Address - Country:US
Mailing Address - Phone:917-747-1059
Mailing Address - Fax:
Practice Address - Street 1:2015 SW 83RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1111
Practice Address - Country:US
Practice Address - Phone:917-747-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3614106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist