Provider Demographics
NPI:1649623430
Name:COTA HEALTH, LLC
Entity type:Organization
Organization Name:COTA HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:COTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:305-928-9073
Mailing Address - Street 1:2950 NE 188TH ST
Mailing Address - Street 2:UNIT 333
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2708
Mailing Address - Country:US
Mailing Address - Phone:786-707-3428
Mailing Address - Fax:
Practice Address - Street 1:2950 NE 188TH ST
Practice Address - Street 2:UNIT 333
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2708
Practice Address - Country:US
Practice Address - Phone:786-707-3428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12710251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health