Provider Demographics
NPI:1083960579
Name:ASTACIO, SORAYA INMACULADA (MH COUNSELOR)
Entity Type:Individual
Prefix:
First Name:SORAYA
Middle Name:INMACULADA
Last Name:ASTACIO
Suffix:
Gender:F
Credentials:MH COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9904 PALMA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3500
Mailing Address - Country:US
Mailing Address - Phone:267-344-9603
Mailing Address - Fax:561-237-5377
Practice Address - Street 1:9904 PALMA VISTA WAY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3500
Practice Address - Country:US
Practice Address - Phone:267-344-9603
Practice Address - Fax:561-237-5377
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health