Provider Demographics
NPI:1821402975
Name:SOTO, NELLYDA (MSW)
Entity Type:Individual
Prefix:MS
First Name:NELLYDA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31212 ALCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6872
Mailing Address - Country:US
Mailing Address - Phone:787-586-5647
Mailing Address - Fax:
Practice Address - Street 1:31212 ALCHESTER DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6872
Practice Address - Country:US
Practice Address - Phone:787-586-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9212101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor