Provider Demographics
NPI:1598942278
Name:CANDELARIA, MIRIAM LUZ (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:LUZ
Last Name:CANDELARIA
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 1:1057 SOARING EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6702
Mailing Address - Country:US
Mailing Address - Phone:941-268-8901
Mailing Address - Fax:
Practice Address - Street 1:1057 SOARING EAGLE LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-6702
Practice Address - Country:US
Practice Address - Phone:941-268-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health