Provider Demographics
NPI:1396995387
Name:SERRA, MARIA TERESA (MS)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:TERESA
Last Name:SERRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6646
Mailing Address - Country:US
Mailing Address - Phone:305-558-2480
Mailing Address - Fax:305-828-3146
Practice Address - Street 1:430 W 66TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6646
Practice Address - Country:US
Practice Address - Phone:305-558-2480
Practice Address - Fax:305-828-3146
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2396101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health