Provider Demographics
NPI:1164630760
Name:PITALUGA, IRIS (LMHC)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:PITALUGA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 S DIXIE HWY STE 1107
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2936
Mailing Address - Country:US
Mailing Address - Phone:305-648-9344
Mailing Address - Fax:305-648-9346
Practice Address - Street 1:1390 S DIXIE HWY STE 1107
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2936
Practice Address - Country:US
Practice Address - Phone:305-648-9344
Practice Address - Fax:305-648-9346
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3991103K00000X
FLMH0003991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9976OtherBLUE CROSS BLUE SHIELD
FLMH 0003991OtherMENTAL HEALTH LICENSE