Provider Demographics
NPI:1679820039
Name:SANTOS ROBLES, LINNETTE (M ED, LMHC)
Entity Type:Individual
Prefix:
First Name:LINNETTE
Middle Name:
Last Name:SANTOS ROBLES
Suffix:
Gender:F
Credentials:M ED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8129 SEDGEWICK CT
Mailing Address - Street 2:APT A
Mailing Address - City:LAKE CLARKE
Mailing Address - State:FL
Mailing Address - Zip Code:33406-8472
Mailing Address - Country:US
Mailing Address - Phone:561-307-5843
Mailing Address - Fax:561-328-3441
Practice Address - Street 1:1499 FOREST HILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CLARKE SHORES
Practice Address - State:FL
Practice Address - Zip Code:33406-6050
Practice Address - Country:US
Practice Address - Phone:561-307-5843
Practice Address - Fax:561-328-3441
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12636101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01675800Medicaid