Provider Demographics
NPI:1356883185
Name:PINO, DANIELA NATALIA
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:NATALIA
Last Name:PINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 W 12TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2258
Mailing Address - Country:US
Mailing Address - Phone:786-306-0968
Mailing Address - Fax:
Practice Address - Street 1:5605 W 12TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2258
Practice Address - Country:US
Practice Address - Phone:786-306-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2024-04-03
Deactivation Date:2024-03-28
Deactivation Code:
Reactivation Date:2024-04-03
Provider Licenses
StateLicense IDTaxonomies
FLMH23479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health