Provider Demographics
NPI:1659383560
Name:DEL SOL, RENE (MA, LMHC, BCPC)
Entity Type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:DEL SOL
Suffix:
Gender:M
Credentials:MA, LMHC, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 US HIGHWAY 27 S
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-9690
Mailing Address - Country:US
Mailing Address - Phone:863-452-0710
Mailing Address - Fax:863-452-0142
Practice Address - Street 1:2523 US HIGHWAY 27 S
Practice Address - Street 2:SUITE 130
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-9690
Practice Address - Country:US
Practice Address - Phone:863-452-0710
Practice Address - Fax:863-452-0142
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761802600Medicaid