Provider Demographics
NPI:1558505818
Name:LEGRA, BERTHA VICTORIA (LMHC, CAP, CH)
Entity Type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:VICTORIA
Last Name:LEGRA
Suffix:
Gender:F
Credentials:LMHC, CAP, CH
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:LEGRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, CAP, CH
Mailing Address - Street 1:3111 SW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2513
Mailing Address - Country:US
Mailing Address - Phone:305-283-2411
Mailing Address - Fax:305-559-1686
Practice Address - Street 1:8180 NW 36TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:305-470-8580
Practice Address - Fax:305-470-8580
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3311101YA0400X
FLMH9692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)