Provider Demographics
NPI:1396332227
Name:STARFATED FAMILY MENTAL HEALTH CARE CORP
Entity type:Organization
Organization Name:STARFATED FAMILY MENTAL HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAZARO
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-537-9457
Mailing Address - Street 1:287 NW 85TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-8332
Mailing Address - Country:US
Mailing Address - Phone:786-537-9457
Mailing Address - Fax:
Practice Address - Street 1:2900 14TH ST N STE 31
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4578
Practice Address - Country:US
Practice Address - Phone:786-537-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty