Provider Demographics
NPI:1215368055
Name:VALDIVIA, RAQUEL (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:
Last Name:VALDIVIA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1516
Mailing Address - Country:US
Mailing Address - Phone:305-490-1067
Mailing Address - Fax:
Practice Address - Street 1:2100 PONCE DE LEON BLVD #1015
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4160
Practice Address - Country:US
Practice Address - Phone:786-405-9050
Practice Address - Fax:786-566-6694
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
205N5OtherBCBS FLA