Provider Demographics
NPI:1093014730
Name:MIRELA ALDEA PHD LLC
Entity Type:Organization
Organization Name:MIRELA ALDEA PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALDEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-331-9592
Mailing Address - Street 1:695 CENTRAL AVE N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-331-9592
Mailing Address - Fax:
Practice Address - Street 1:695 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3669
Practice Address - Country:US
Practice Address - Phone:727-331-9592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7909103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty