Healthcare Provider Details

I. General information

NPI: 1285144998
Provider Name (Legal Business Name): MABEL AMBAR MELENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 FOREST HILL BLVD
WEST PALM BEACH FL
33406-5931
US

IV. Provider business mailing address

2406 E HINSON AVE
HAINES CITY FL
33844-4945
US

V. Phone/Fax

Practice location:
  • Phone: 561-616-8411
  • Fax:
Mailing address:
  • Phone: 267-230-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: