Provider Demographics
NPI:1356674253
Name:MIRACOLO, MELISSA SOSA (MS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:SOSA
Last Name:MIRACOLO
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MISS
Other - First Name:RIAMA
Other - Middle Name:MELISSA
Other - Last Name:SOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:125 SW 8TH AVE STE 27B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4658
Mailing Address - Country:US
Mailing Address - Phone:786-218-7382
Mailing Address - Fax:
Practice Address - Street 1:1818 S AUSTRALIAN AVE STE 420
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6447
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13464103K00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst