Healthcare Provider Details

I. General information

NPI: 1871152074
Provider Name (Legal Business Name): MICAELA SUSANA BAREDES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 NE 212TH TER
AVENTURA FL
33180-3692
US

IV. Provider business mailing address

3212 NE 212TH TER
AVENTURA FL
33180-3692
US

V. Phone/Fax

Practice location:
  • Phone: 786-602-2565
  • Fax: 786-602-2565
Mailing address:
  • Phone: 786-602-2565
  • Fax: 786-602-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: