Provider Demographics
NPI:1154347706
Name:SOUTHEASTERN COMMUNITY MENTAL HEALTH CENTER INC
Entity type:Organization
Organization Name:SOUTHEASTERN COMMUNITY MENTAL HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMEJO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:305-383-6565
Mailing Address - Street 1:13550 SW 88TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1540
Mailing Address - Country:US
Mailing Address - Phone:305-383-6565
Mailing Address - Fax:305-383-7767
Practice Address - Street 1:13550 SW 88TH ST STE 130
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1540
Practice Address - Country:US
Practice Address - Phone:305-383-6565
Practice Address - Fax:305-383-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002011400Medicaid
FL9792421OtherAETNA
FL002011400Medicaid