Healthcare Provider Details

I. General information

NPI: 1306256268
Provider Name (Legal Business Name): NANCY ISABEL PEDERSEN MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2014
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 BISCAYNE BLVD
MIAMI FL
33137-2639
US

IV. Provider business mailing address

15018 SW 140TH CT
MIAMI FL
33186-5724
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-6417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: