Provider Demographics
NPI:1639271083
Name:PROENZA, MAGDA NORELYS (LMFT, BCBA)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:NORELYS
Last Name:PROENZA
Suffix:
Gender:F
Credentials:LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 SW 137TH AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6355
Mailing Address - Country:US
Mailing Address - Phone:305-815-6272
Mailing Address - Fax:
Practice Address - Street 1:2721 SW 137TH AVE STE 113
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6355
Practice Address - Country:US
Practice Address - Phone:305-815-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2848106H00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist