Provider Demographics
NPI:1679114904
Name:MIAMI CENTER FOR WELLNESS AND AGING
Entity type:Organization
Organization Name:MIAMI CENTER FOR WELLNESS AND AGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-613-6650
Mailing Address - Street 1:721 TIBIDABO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6226
Mailing Address - Country:US
Mailing Address - Phone:917-613-6650
Mailing Address - Fax:
Practice Address - Street 1:1550 MADRUGA AVE STE 313
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3070
Practice Address - Country:US
Practice Address - Phone:917-613-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty