Provider Demographics
NPI:1720352743
Name:MAMBUCA, ANDRES FELICIANO (PSYD, MS, LMHC)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:FELICIANO
Last Name:MAMBUCA
Suffix:
Gender:
Credentials:PSYD, MS, LMHC
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Mailing Address - Street 1:3311 SW 195TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5881
Mailing Address - Country:US
Mailing Address - Phone:954-663-8086
Mailing Address - Fax:954-251-7005
Practice Address - Street 1:1921 NW 150TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2872
Practice Address - Country:US
Practice Address - Phone:954-251-7005
Practice Address - Fax:954-251-7005
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11089101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health