Provider Demographics
NPI:1740831692
Name:SOBALVARRO, MARIO
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:SOBALVARRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 WEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3077
Mailing Address - Country:US
Mailing Address - Phone:561-805-0660
Mailing Address - Fax:
Practice Address - Street 1:218 WEDGEWOOD CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3077
Practice Address - Country:US
Practice Address - Phone:561-805-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist