Provider Demographics
NPI:1427683432
Name:CUTLER BAY MENTAL HEALTH CORP
Entity type:Organization
Organization Name:CUTLER BAY MENTAL HEALTH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAYANAIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ CASABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-925-7297
Mailing Address - Street 1:10665 SW 190TH ST STE 32133214
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7651
Mailing Address - Country:US
Mailing Address - Phone:786-925-7297
Mailing Address - Fax:
Practice Address - Street 1:10665 SW 190TH ST STE 32133214
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7651
Practice Address - Country:US
Practice Address - Phone:786-925-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL781324Medicaid