Healthcare Provider Details

I. General information

NPI: 1679820039
Provider Name (Legal Business Name): LINNETTE SANTOS ROBLES M. ED., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 FOREST HILL BLVD STE 101
LAKE CLARKE SHORES FL
33406-6050
US

IV. Provider business mailing address

8129 SEDGEWICK CT APT A
LAKE CLARKE FL
33406-8472
US

V. Phone/Fax

Practice location:
  • Phone: 561-307-5843
  • Fax: 561-328-3441
Mailing address:
  • Phone: 561-307-5843
  • Fax: 561-328-3441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: