Provider Demographics
NPI:1558747964
Name:RAQUEL VALDIVIA, LMHC, PA
Entity Type:Organization
Organization Name:RAQUEL VALDIVIA, LMHC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDIVIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-405-9050
Mailing Address - Street 1:2100 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 1015
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5215
Mailing Address - Country:US
Mailing Address - Phone:786-405-9050
Mailing Address - Fax:786-566-6694
Practice Address - Street 1:2100 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 1015
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5215
Practice Address - Country:US
Practice Address - Phone:786-405-9050
Practice Address - Fax:786-566-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)