Provider Demographics
NPI:1144359753
Name:BRITO, IBIS (PSYD, LMHC)
Entity type:Individual
Prefix:DR
First Name:IBIS
Middle Name:
Last Name:BRITO
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 E 10TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2519
Mailing Address - Country:US
Mailing Address - Phone:786-553-6757
Mailing Address - Fax:305-685-4550
Practice Address - Street 1:2300 N COMMERCE PKWY
Practice Address - Street 2:SUITE #111
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3254
Practice Address - Country:US
Practice Address - Phone:786-553-6757
Practice Address - Fax:305-685-4550
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health