Provider Demographics
NPI:1821736547
Name:BERMUDEZ, MARIANELA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MARIANELA
Middle Name:
Last Name:BERMUDEZ
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 1:599 PIGEON PLUM WAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-2460
Mailing Address - Country:US
Mailing Address - Phone:832-465-2562
Mailing Address - Fax:
Practice Address - Street 1:599 PIGEON PLUM WAY
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33327-2460
Practice Address - Country:US
Practice Address - Phone:832-465-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty