Healthcare Provider Details

I. General information

NPI: 1689538076
Provider Name (Legal Business Name): MRS. ANA PAULA CONEGUNDES VIEIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 15TH AVE N
LAKE WORTH FL
33460-1724
US

IV. Provider business mailing address

1243 15TH AVE N
LAKE WORTH FL
33460-1724
US

V. Phone/Fax

Practice location:
  • Phone: 561-317-3819
  • Fax:
Mailing address:
  • Phone: 561-317-3819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: