Provider Demographics
NPI:1174364160
Name:BERMUDEZ, MICHAELA BELLE
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:BELLE
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11946 SW 253RD TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6010
Mailing Address - Country:US
Mailing Address - Phone:305-608-1963
Mailing Address - Fax:
Practice Address - Street 1:513 FLEMING ST STE 14
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6887
Practice Address - Country:US
Practice Address - Phone:305-453-6337
Practice Address - Fax:305-453-6374
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-289422106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician