Provider Demographics
NPI:1679374243
Name:MENTAL HEALTH GROUP PRIVATE PRACTICE PLLC
Entity type:Organization
Organization Name:MENTAL HEALTH GROUP PRIVATE PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:917-592-2345
Mailing Address - Street 1:2 CHARLTON ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4917
Mailing Address - Country:US
Mailing Address - Phone:917-592-2345
Mailing Address - Fax:
Practice Address - Street 1:14211 SW 120TH ST
Practice Address - Street 2:# 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:917-592-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty