Provider Demographics
NPI:1518014547
Name:ASTOLFO, THERESE A (LMHC)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:A
Last Name:ASTOLFO
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 1:1680 MERIDIAN AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2703
Mailing Address - Country:US
Mailing Address - Phone:305-531-5341
Mailing Address - Fax:305-532-5322
Practice Address - Street 1:1680 MERIDIAN AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2703
Practice Address - Country:US
Practice Address - Phone:305-531-5341
Practice Address - Fax:305-532-5322
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6086101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766841400Medicaid
FL753941000Medicaid