Provider Demographics
NPI:1427055417
Name:DADE FAMILY COUNSELING COMMUNITY MENTAL HEALTH CENTER, INC
Entity type:Organization
Organization Name:DADE FAMILY COUNSELING COMMUNITY MENTAL HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDARO
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:786-548-1022
Mailing Address - Street 1:9350 SUNSET DR STE 151
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3286
Mailing Address - Country:US
Mailing Address - Phone:786-548-1022
Mailing Address - Fax:305-774-9573
Practice Address - Street 1:9350 SUNSET DR STE 151
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3286
Practice Address - Country:US
Practice Address - Phone:786-548-1022
Practice Address - Fax:786-542-5326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
FL101454261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114064400Medicaid
FL114064700Medicaid
FL114064000Medicaid
FL114065300Medicaid
FL114065300Medicaid