Provider Demographics
NPI:1548608342
Name:FONTANALS, VALERIA (EDM, SS)
Entity Type:Individual
Prefix:MRS
First Name:VALERIA
Middle Name:
Last Name:FONTANALS
Suffix:
Gender:F
Credentials:EDM, SS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 BRICKELL KEY DR
Mailing Address - Street 2:APT 700
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2661
Mailing Address - Country:US
Mailing Address - Phone:786-393-7955
Mailing Address - Fax:
Practice Address - Street 1:888 BRICKELL KEY DR
Practice Address - Street 2:APT 700
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2661
Practice Address - Country:US
Practice Address - Phone:786-393-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1140103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821410036OtherBUSINESS