Provider Demographics
NPI:1245492404
Name:ELGUETA, VIVINA (LMHC)
Entity type:Individual
Prefix:
First Name:VIVINA
Middle Name:
Last Name:ELGUETA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:VIVINA
Other - Middle Name:
Other - Last Name:ELGUETA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:111 NW 183RD ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4537
Mailing Address - Country:US
Mailing Address - Phone:305-892-4600
Mailing Address - Fax:305-493-0814
Practice Address - Street 1:111 NW 183RD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4537
Practice Address - Country:US
Practice Address - Phone:305-892-4600
Practice Address - Fax:305-493-0814
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9144101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health