Provider Demographics
NPI:1609492784
Name:ABREU, AMANDA (MH)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ABREU
Suffix:
Gender:F
Credentials:MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21280 SW 124TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-5781
Mailing Address - Country:US
Mailing Address - Phone:786-328-3042
Mailing Address - Fax:
Practice Address - Street 1:11110 N KENDALL DR STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-0938
Practice Address - Country:US
Practice Address - Phone:305-596-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17978101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health