Provider Demographics
NPI:1598427866
Name:BRAIN & BEHAVIORAL INSTITUTE OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:BRAIN & BEHAVIORAL INSTITUTE OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:LUCENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-778-6795
Mailing Address - Street 1:1801 CORAL WAY STE 327
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2784
Mailing Address - Country:US
Mailing Address - Phone:305-778-6795
Mailing Address - Fax:
Practice Address - Street 1:1801 CORAL WAY STE 327
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2784
Practice Address - Country:US
Practice Address - Phone:305-778-6795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109270200Medicaid