# MILLENIUM MEDICAL GROUP CORP.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1093287377
- **Authorized official:** DAMARYS QUIRIELLO (PRESIDENT)
- **Authorized official phone:** (786) 332-4330

## Contact information

- **Practice address:** 2720 SW 97TH AVE STE C105, MIAMI, FL 33165-2677
- **Practice address phone:** (786) 332-4330
- **Practice address fax:** (786) 332-4109
- **Mailing address:** 2720 SW 97TH AVE STE C105, MIAMI, FL 33165-2677
- **Mailing address phone:** (786) 332-4330
- **Mailing address fax:** (786) 332-4109

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |

## Other

- **Enumeration date:** 12/26/2018
- **Last updated:** 03/06/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 023735400 | — | FL |