Healthcare Provider Details

I. General information

NPI: 1558985135
Provider Name (Legal Business Name): MORGAN OLIVIA DEAMEZOLA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2020
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 7TH AVE STE 300
MIAMI FL
33136-1112
US

IV. Provider business mailing address

8971 SW 182ND TER
PALMETTO BAY FL
33157-5947
US

V. Phone/Fax

Practice location:
  • Phone: 305-902-6347
  • Fax:
Mailing address:
  • Phone: 202-468-9450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: