Provider Demographics
NPI:1285308965
Name:JCW MENTAL HEALTH LLC
Entity type:Organization
Organization Name:JCW MENTAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHABELY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAPANES PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-695-2202
Mailing Address - Street 1:19812 SW 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-4355
Mailing Address - Country:US
Mailing Address - Phone:786-695-2202
Mailing Address - Fax:
Practice Address - Street 1:7392 NW 35TH TER STE 303
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1260
Practice Address - Country:US
Practice Address - Phone:786-695-2202
Practice Address - Fax:786-536-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-05
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health