Provider Demographics
NPI:1689299703
Name:MIAMI BEACH BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:MIAMI BEACH BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:CCASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-766-8064
Mailing Address - Street 1:1354 WASHINGTON AVE STE 221
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4203
Mailing Address - Country:US
Mailing Address - Phone:305-766-8064
Mailing Address - Fax:305-899-5165
Practice Address - Street 1:1354 WASHINGTON AVE STE 221
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-4203
Practice Address - Country:US
Practice Address - Phone:305-766-8064
Practice Address - Fax:305-899-5165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty