Provider Demographics
NPI:1700445202
Name:D'AQUIN, INGRID
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:D'AQUIN
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 1:14232 SW 117TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8635
Mailing Address - Country:US
Mailing Address - Phone:786-277-3013
Mailing Address - Fax:
Practice Address - Street 1:2000 S DIXIE HWY STE 104
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2441
Practice Address - Country:US
Practice Address - Phone:786-277-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health