Provider Demographics
NPI:1396521142
Name:ACOSTA, ILEANA SARAI (LMHC)
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:SARAI
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ILEANA
Other - Middle Name:SARAI
Other - Last Name:MONCADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10712 SW 123RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3728
Mailing Address - Country:US
Mailing Address - Phone:915-875-6486
Mailing Address - Fax:
Practice Address - Street 1:10712 SW 123RD CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3728
Practice Address - Country:US
Practice Address - Phone:915-875-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22701101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health