Provider Demographics
NPI:1972196608
Name:MANSO, KRYSTYNA ISEL (LMHC)
Entity Type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:ISEL
Last Name:MANSO
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 1:3883 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3732
Mailing Address - Country:US
Mailing Address - Phone:305-576-6611
Mailing Address - Fax:
Practice Address - Street 1:2691 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4414
Practice Address - Country:US
Practice Address - Phone:305-556-6611
Practice Address - Fax:786-476-2813
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109801900Medicaid