Provider Demographics
NPI:1548546369
Name:MENA, HUMBERTO (MSC, LMHC, BCBA)
Entity type:Individual
Prefix:MR
First Name:HUMBERTO
Middle Name:
Last Name:MENA
Suffix:
Gender:M
Credentials:MSC, LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5861 SW 155TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2535
Mailing Address - Country:US
Mailing Address - Phone:786-277-3168
Mailing Address - Fax:305-220-3383
Practice Address - Street 1:3850 SW 87TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5474
Practice Address - Country:US
Practice Address - Phone:305-220-3382
Practice Address - Fax:305-220-3383
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14969101YM0800X
FLBCBA1-16-22872103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017914800Medicaid