Provider Demographics
NPI:1457561144
Name:ANDERSON, RAQUEL LOURDES (LMHC)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:LOURDES
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9168
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468
Mailing Address - Country:US
Mailing Address - Phone:561-741-0000
Mailing Address - Fax:561-741-0002
Practice Address - Street 1:3401 PGA BLVD
Practice Address - Street 2:STE #300
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-254-5616
Practice Address - Fax:561-627-0094
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7599101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health