Healthcare Provider Details

I. General information

NPI: 1780994699
Provider Name (Legal Business Name): MARIANELLA VALERA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NE 2ND AVE
MIAMI FL
33132-1000
US

IV. Provider business mailing address

1801 NE 2ND AVE
MIAMI FL
33132-1000
US

V. Phone/Fax

Practice location:
  • Phone: 305-371-5777
  • Fax: 305-371-6007
Mailing address:
  • Phone: 305-371-5777
  • Fax: 305-371-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH6244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: