Provider Demographics
NPI:1760046718
Name:BECERRA, MARIA M (DR)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:BECERRA
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15112 SW 140TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5731
Mailing Address - Country:US
Mailing Address - Phone:786-553-6165
Mailing Address - Fax:
Practice Address - Street 1:22320 MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-4456
Practice Address - Country:US
Practice Address - Phone:786-553-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-180101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral