Provider Demographics
NPI:1700561685
Name:NEW LIFE MENTAL HEALTH COMMUNITY CENTER
Entity Type:Organization
Organization Name:NEW LIFE MENTAL HEALTH COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YAIMARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERNANDEZ GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-548-6774
Mailing Address - Street 1:10700 CARIBBEAN BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1232
Mailing Address - Country:US
Mailing Address - Phone:786-250-3040
Mailing Address - Fax:786-250-3050
Practice Address - Street 1:10700 CARIBBEAN BLVD STE 402
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1232
Practice Address - Country:US
Practice Address - Phone:786-250-3040
Practice Address - Fax:786-250-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty