Provider Demographics
NPI:1598944225
Name:UNIVERSITY COUNSELING CENTER
Entity Type:Organization
Organization Name:UNIVERSITY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SERNA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-603-7867
Mailing Address - Street 1:2451 BRICKELL AVE
Mailing Address - Street 2:SUITE 16-G
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2436
Mailing Address - Country:US
Mailing Address - Phone:305-328-5621
Mailing Address - Fax:954-905-4399
Practice Address - Street 1:8030 PETERS RD
Practice Address - Street 2:D 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4038
Practice Address - Country:US
Practice Address - Phone:954-475-9503
Practice Address - Fax:954-905-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2014-08-29
Deactivation Date:2014-06-24
Deactivation Code:
Reactivation Date:2014-08-29
Provider Licenses
StateLicense IDTaxonomies
FLSW7020261QM0850X
FLMT2274261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health