Healthcare Provider Details

I. General information

NPI: 1386113249
Provider Name (Legal Business Name): YIOLANTA SOFIALI-BRUNVERT LMHC, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YOLANDA SOFIALI LMHC

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 GLADES RD STE 107
BOCA RATON FL
33431-7260
US

IV. Provider business mailing address

873 SPRINGDALE CIR
PALM SPRINGS FL
33461-1527
US

V. Phone/Fax

Practice location:
  • Phone: 561-660-1692
  • Fax:
Mailing address:
  • Phone: 561-660-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: