Provider Demographics
NPI:1790561660
Name:TUDELA, ESTA (LCSW)
Entity Type:Individual
Prefix:
First Name:ESTA
Middle Name:
Last Name:TUDELA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 SW 33RD ST APT A
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5324
Mailing Address - Country:US
Mailing Address - Phone:786-715-3039
Mailing Address - Fax:
Practice Address - Street 1:6143 SW 33RD ST APT A
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5324
Practice Address - Country:US
Practice Address - Phone:786-715-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW220291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical