Healthcare Provider Details

I. General information

NPI: 1659798593
Provider Name (Legal Business Name): IDA SANFIEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 WEST FLAGLER ST., STE. 100 DADE FAMILY COUNSELING
MIAMI FL
33134
US

IV. Provider business mailing address

11474 SW 75TH TER
MIAMI FL
33173-2651
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-9570
  • Fax:
Mailing address:
  • Phone: 786-325-3285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH12241
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: