Provider Demographics
NPI:1407431778
Name:DYER, MIOSOTYS
Entity Type:Individual
Prefix:
First Name:MIOSOTYS
Middle Name:
Last Name:DYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7129 150TH CT N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1923
Mailing Address - Country:US
Mailing Address - Phone:561-234-6637
Mailing Address - Fax:561-965-9231
Practice Address - Street 1:3678 S CONGRESS AVE STE 2
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3700
Practice Address - Country:US
Practice Address - Phone:561-965-6980
Practice Address - Fax:561-965-9231
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health