MEDICARE: BLANCA ISABEL ESTRADA MS, NCC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH 2861	FL
2	101YP2500X	Professional Counselor	PC003364	PA

General Provider Information

NPI Number	:	1396948592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLANCA ISABEL ESTRADA MS, NCC, LPC

Provider Business Mailing Address
First Line	:	1861 HIDDEN TRAIL LN
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1456
Country	:	US
Telephone Number	:	954-323-8585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 S DIXIE HWY
Second Line	:	SUITE 1140
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2926
Country	:	US
Telephone Number	:	305-668-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	08/16/2011

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