Provider Demographics
NPI:1508072737
Name:SOTO, JORGE A SR (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:A
Last Name:SOTO
Suffix:SR
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:JORGE
Other - Middle Name:A
Other - Last Name:SOTO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:550 VITTORIO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2737
Mailing Address - Country:US
Mailing Address - Phone:305-796-0582
Mailing Address - Fax:
Practice Address - Street 1:9445 SW 40TH ST STE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4001
Practice Address - Country:US
Practice Address - Phone:305-796-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health