Provider Demographics
NPI:1417411406
Name:MOLDOVAN, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MOLDOVAN
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 1:7744 SW 99TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-8101
Mailing Address - Country:US
Mailing Address - Phone:305-710-1465
Mailing Address - Fax:
Practice Address - Street 1:9245 SW 157TH ST STE 203
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1975
Practice Address - Country:US
Practice Address - Phone:305-254-1928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health