Provider Demographics
NPI:1467762245
Name:SAM, PEDRO DONOSSO (LMHC)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:DONOSSO
Last Name:SAM
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:305-891-0050
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:11440 N KENDALL DR STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1024
Practice Address - Country:US
Practice Address - Phone:305-279-5535
Practice Address - Fax:305-279-2742
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health