Healthcare Provider Details

I. General information

NPI: 1477203495
Provider Name (Legal Business Name): LAURA ISABEL DIAZ ABREU RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3067 SW 18TH ST
MIAMI FL
33145-1917
US

IV. Provider business mailing address

3067 SW 18TH ST
MIAMI FL
33145-1917
US

V. Phone/Fax

Practice location:
  • Phone: 786-370-8034
  • Fax:
Mailing address:
  • Phone: 786-370-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: