Provider Demographics
NPI:1407879166
Name:MALDONADO DIAZ, IVETTE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:
Last Name:MALDONADO DIAZ
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 1:1045 SW 159TH LANE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-430-8657
Mailing Address - Fax:954-249-1975
Practice Address - Street 1:18503 PINES BOULEVARD
Practice Address - Street 2:SUITE 310
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029
Practice Address - Country:US
Practice Address - Phone:954-999-4786
Practice Address - Fax:954-999-4786
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health