| Mental Autonomy Inc | |
|
5220 S University Dr Ste 204c Davie FL 33328-5308 | |
| (954) 906-5947 | |
| (786) 329-6876 |
| Full Name | Mental Autonomy Inc |
|---|---|
| Speciality | Case Management |
| Location | 5220 S University Dr Ste 204c, Davie, Florida |
| Authorized Official Name and Position | Luis Perozo (OFFICER) |
| Authorized Official Contact | 9549065947 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Autonomy Inc 5220 S University Dr Ste 204c Davie FL 33328-5308 Ph: (954) 906-5947 | Mental Autonomy Inc 5220 S University Dr Ste 204c Davie FL 33328-5308 Ph: (954) 906-5947 |
| NPI Number | 1982170700 |
|---|---|
| Provider Enumeration Date | 10/19/2018 |
| Last Update Date | 11/16/2022 |
| Certification Date | 11/16/2022 |
| Medicare PECOS PAC ID | 1355727256 |
|---|---|
| Medicare Enrollment ID | O20220929002756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982170700 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
| Provider Name | Magda Erira |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407223993 PECOS PAC ID: 8325438690 Enrollment ID: I20211130001232 |
| Provider Name | Jose Miguel Morales Gonzalez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972132512 PECOS PAC ID: 6204361561 Enrollment ID: I20241122002074 |
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