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General NPI Number Information
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NPI Number | 1215295068
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Entity Type | Individual
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Provider Name | IDALMIS NODAL LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 9600 SW 8TH ST SUITE # 1
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City | MIAMI
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State | FL
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Zip | 33174-2900
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Country | US
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Telephone | 305-559-8838
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Fax | 305-559-6608
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Provider Business Mailing Address
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Address Line | 15630 SW 58TH ST
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City | MIAMI
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State | FL
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Zip | 33193-2524
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Country | US
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Telephone | 786-247-6496
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Fax | 305-383-3296
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 9656
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License Number State | FL
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