Provider Demographics
NPI:1841838265
Name:MENTAL HEALTHNETWORK , INC
Entity type:Organization
Organization Name:MENTAL HEALTHNETWORK , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDERRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-998-4949
Mailing Address - Street 1:91831 OVERSEAS HWY STE C
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2647
Mailing Address - Country:US
Mailing Address - Phone:305-998-4949
Mailing Address - Fax:305-998-4680
Practice Address - Street 1:91831 OVERSEAS HWY STE C
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2647
Practice Address - Country:US
Practice Address - Phone:305-998-4949
Practice Address - Fax:305-998-4680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108007500Medicaid