Provider Demographics
NPI:1548429889
Name:BECERRA, AMALIA BERNARDA (MS)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:BERNARDA
Last Name:BECERRA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10211 FONTAINEBLEAU BLVD APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3214
Mailing Address - Country:US
Mailing Address - Phone:215-888-1368
Mailing Address - Fax:
Practice Address - Street 1:2050 W 56TH ST STE 15-16
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2601
Practice Address - Country:US
Practice Address - Phone:305-557-1555
Practice Address - Fax:305-397-2847
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health