Healthcare Provider Details

I. General information

NPI: 1558505818
Provider Name (Legal Business Name): BERTHA VICTORIA LEGRA LMHC, CMHC, MCAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA LEGRA LMHC, CMHC, MCAP

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE 36TH ST APT 605
MIAMI FL
33137-3930
US

IV. Provider business mailing address

600 NE 36TH ST APT 605
MIAMI FL
33137-3930
US

V. Phone/Fax

Practice location:
  • Phone: 305-283-2411
  • Fax:
Mailing address:
  • Phone: 305-283-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9692
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: