Provider Demographics
NPI:1992036198
Name:YZAGUIRRE-KELLEY, MARITSA (LMHC, MCAP, CMHP)
Entity Type:Individual
Prefix:DR
First Name:MARITSA
Middle Name:
Last Name:YZAGUIRRE-KELLEY
Suffix:
Gender:F
Credentials:LMHC, MCAP, CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 GLADES RD STE 324
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-8571
Mailing Address - Country:US
Mailing Address - Phone:561-758-0574
Mailing Address - Fax:
Practice Address - Street 1:2255 GLADES RD STE 324
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8571
Practice Address - Country:US
Practice Address - Phone:561-758-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11108101YM0800X
FL6791101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1025Medicaid