Provider Demographics
NPI:1679791149
Name:QUINONES, PEREZ, MARIA DEL C (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:DEL C
Last Name:QUINONES, PEREZ
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 1:3991 SW GREEWNWOOD WAY SUITE 3G
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4639
Mailing Address - Country:US
Mailing Address - Phone:772-634-1400
Mailing Address - Fax:772-221-2433
Practice Address - Street 1:3991 SW GREEWNWOOD WAY
Practice Address - Street 2:3-G
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990
Practice Address - Country:US
Practice Address - Phone:772-634-1400
Practice Address - Fax:772-221-2433
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7196101YM0800X
FLMH7196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600248011OtherMAGELLAV
FLZ037UOtherBLUE CROSS BLUE SHIELD
FL000672700Medicaid