Provider Demographics
NPI:1912355496
Name:COLON PASTRANA, IVANETTE (LMHC)
Entity Type:Individual
Prefix:
First Name:IVANETTE
Middle Name:
Last Name:COLON PASTRANA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7482
Mailing Address - Country:US
Mailing Address - Phone:305-749-8617
Mailing Address - Fax:
Practice Address - Street 1:7601 E TREASURE DR
Practice Address - Street 2:CU1
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4391
Practice Address - Country:US
Practice Address - Phone:305-302-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 13772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health