Provider Demographics
NPI:1083253637
Name:TABLADA, MELISSA PASCAL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:PASCAL
Last Name:TABLADA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:PASCAL
Other - Last Name:GUARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 SW 99TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:786-753-9391
Mailing Address - Fax:
Practice Address - Street 1:7100 SW 99TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:786-753-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3756106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist