Provider Demographics
NPI:1003381096
Name:DEL VALLE-IZURIETA, CARMEN LYDIA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LYDIA
Last Name:DEL VALLE-IZURIETA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9838 OLD BAYMEADOWS RD # 182
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8101
Mailing Address - Country:US
Mailing Address - Phone:904-923-3031
Mailing Address - Fax:904-592-8681
Practice Address - Street 1:2950 HALCYON LN STE 701
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6692
Practice Address - Country:US
Practice Address - Phone:904-923-3031
Practice Address - Fax:904-592-8681
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMH16334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health