Active NPI
Andrea Mantilla, M.S.
- Mental Health Counselor
- Plantation, FL
National Provider Identifier
1972241180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 19064
- Practice address
- 4330 W Broward Blvd Ste I
Plantation, FL 33317-3753 - Phone
- (954) 372-0423
- NPI assigned
- May 26, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 19064 | FL | Primary |
Addresses
Primary practice location
4330 W Broward Blvd Ste I
Plantation, FL 33317-3753
Mailing address
45 SW 9TH St Apt 3902
Miami, FL 33130-3986
Phone (954) 804-6480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19064 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653523200000",
"number": "1972241180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45 SW 9TH ST APT 3902",
"city": "MIAMI",
"state": "FL",
"postal_code": "331303986",
"telephone_number": "954-804-6480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4330 W BROWARD BLVD STE I",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333173753",
"telephone_number": "954-372-0423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANTILLA",
"first_name": "ANDREA",
"credential": "M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-05-26",
"last_updated": "2022-05-26",
"certification_date": "2022-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "19064",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plantation, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.