Organization
MILLENIUM MEDICAL GROUP CORP.
Active
Organization subpart
Yes
Provider details
NPI number
Authorized official
DAMARYS QUIRIELLO (PRESIDENT)
(786) 332-4330
Entity
Organization
Contact information
Practice address
2720 SW 97TH AVE STE C105, MIAMI, FL 33165-2677
(786) 332-4330
(786) 332-4109
Mailing address
2720 SW 97TH AVE STE C105, MIAMI, FL 33165-2677
(786) 332-4330
(786) 332-4109
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
207QA0505X
Adult Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023735400
—
FL
Enumeration date
12/26/2018
Last updated
03/06/2025
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