=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225228976
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA ROSA FLEITES LMHC, PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2007
-----------------------------------------------------
Last Update Date | 01/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7821 CORAL WAY SUITE#: 100
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-6542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-269-8550
-----------------------------------------------------
Fax | 305-269-8558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7755 SW 86TH ST APT#: C-103
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-7288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-298-0361
-----------------------------------------------------
Fax | 305-269-8558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH7327
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------