Provider Demographics
NPI:1679603567
Name:ARREAZA, MARISELA
Entity Type:Individual
Prefix:MISS
First Name:MARISELA
Middle Name:
Last Name:ARREAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 SW 56TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-2270
Mailing Address - Country:US
Mailing Address - Phone:305-740-7252
Mailing Address - Fax:305-597-9495
Practice Address - Street 1:7392 NW 35TH TER
Practice Address - Street 2:SUITES 201 AND 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1271
Practice Address - Country:US
Practice Address - Phone:305-597-9494
Practice Address - Fax:305-597-9495
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5923101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health