| Tal Community Mental Health Center Llc | |
|
12781 Miramar Parkway Suite 203 Miramar FL 33027 | |
| (786) 648-3588 | |
| (786) 698-7677 |
| Full Name | Tal Community Mental Health Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 12781 Miramar Parkway, Miramar, Florida |
| Authorized Official Name and Position | Gaston I Bogomolni (OWNER-CFO) |
| Authorized Official Contact | 7866483588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tal Community Mental Health Center Llc 12781 Miramar Parkway Suite 203 Miramar FL 33027 Ph: (786) 648-3588 | Tal Community Mental Health Center Llc 12781 Miramar Parkway Suite 203 Miramar FL 33027 Ph: (786) 648-3588 |
| NPI Number | 1235715236 |
|---|---|
| Provider Enumeration Date | 03/20/2021 |
| Last Update Date | 12/12/2022 |
| Certification Date | 12/12/2022 |
| Medicare PECOS PAC ID | 7012311657 |
|---|---|
| Medicare Enrollment ID | O20210804002694 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235715236 | NPI | - | NPPES |
| 109921400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | David H Levine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396133534 PECOS PAC ID: 0648573618 Enrollment ID: I20160125002837 |
| Provider Name | Patricia Hernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598398547 PECOS PAC ID: 5890105134 Enrollment ID: I20201028000329 |
| Provider Name | Pablo Lorenzo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740685767 PECOS PAC ID: 1557760493 Enrollment ID: I20210526002978 |
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