Provider Demographics
NPI:1558635805
Name:CARMEN PEREZ-ILLADE LMHC INC
Entity Type:Organization
Organization Name:CARMEN PEREZ-ILLADE LMHC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-ILLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LMHC
Authorized Official - Phone:407-430-6300
Mailing Address - Street 1:2802 ALOMA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3532
Mailing Address - Country:US
Mailing Address - Phone:407-430-6300
Mailing Address - Fax:407-628-3300
Practice Address - Street 1:2802 ALOMA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3532
Practice Address - Country:US
Practice Address - Phone:407-430-6300
Practice Address - Fax:407-628-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9110251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health