Provider Demographics
NPI:1033645973
Name:SOSA-MIRACOLO COUNSELING SERVICES, L.L.C.
Entity Type:Organization
Organization Name:SOSA-MIRACOLO COUNSELING SERVICES, L.L.C.
Other - Org Name:MELISSA SOSA-MIRACOLO, LMHC COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SOSA
Authorized Official - Last Name:MIRACOLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-218-7382
Mailing Address - Street 1:2312 WILTON DR
Mailing Address - Street 2:SUITE 27B
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1249
Mailing Address - Country:US
Mailing Address - Phone:786-218-7382
Mailing Address - Fax:
Practice Address - Street 1:2312 WILTON DR
Practice Address - Street 2:SUITE 27B
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1249
Practice Address - Country:US
Practice Address - Phone:786-218-7382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL17000053198261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center