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General NPI Number Information
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NPI Number | 1285925578
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Entity Type | Individual
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Provider Name | CORTINA DERAL PETERS LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 3600 BROADWAY # US1
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-4844
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Country | US
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Telephone | 561-228-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 AVENUE F
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-7529
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Country | US
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Telephone | 561-315-5939
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Fax |
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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 | IMH7942
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11172
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License Number State | FL
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