Provider Demographics
NPI:1346904752
Name:FLEITAS, NATHALIE C (MSED, LMHC)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:C
Last Name:FLEITAS
Suffix:
Gender:F
Credentials:MSED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 N KENDALL DR STE 231
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1556
Mailing Address - Country:US
Mailing Address - Phone:305-859-1360
Mailing Address - Fax:
Practice Address - Street 1:10661 N KENDALL DR STE 231
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1556
Practice Address - Country:US
Practice Address - Phone:305-859-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health