Provider Demographics
NPI:1811534753
Name:BOUCOURT, ARMANDO DE LA CARIDAD
Entity type:Individual
Prefix:
First Name:ARMANDO
Middle Name:DE LA CARIDAD
Last Name:BOUCOURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 SW 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1954
Mailing Address - Country:US
Mailing Address - Phone:786-486-9043
Mailing Address - Fax:
Practice Address - Street 1:144 NW 37TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3111
Practice Address - Country:US
Practice Address - Phone:305-767-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104999800Medicaid