Provider Demographics
NPI:1912068719
Name:PETRLAK, AIDA JANETH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:JANETH
Last Name:PETRLAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:AIDA
Other - Middle Name:JANETH
Other - Last Name:BERRIOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:7508 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5328
Mailing Address - Country:US
Mailing Address - Phone:954-986-9218
Mailing Address - Fax:
Practice Address - Street 1:1265 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2140
Practice Address - Country:US
Practice Address - Phone:305-547-6827
Practice Address - Fax:305-547-6848
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 1540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist