Provider Demographics
NPI:1881215457
Name:ANDINO, PATRICIA MARIA (IMH)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIA
Last Name:ANDINO
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 WOODBINE WAY APT 519
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6548
Mailing Address - Country:US
Mailing Address - Phone:787-460-6130
Mailing Address - Fax:
Practice Address - Street 1:3333 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5812
Practice Address - Country:US
Practice Address - Phone:561-635-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19556101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health