Provider Demographics
NPI:1952170045
Name:AVILA, MARYLUPE
Entity Type:Individual
Prefix:
First Name:MARYLUPE
Middle Name:
Last Name:AVILA
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 1:261 NAVARRE AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4425
Mailing Address - Country:US
Mailing Address - Phone:954-830-7732
Mailing Address - Fax:
Practice Address - Street 1:2141 SW 1ST ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1695
Practice Address - Country:US
Practice Address - Phone:305-644-6024
Practice Address - Fax:305-644-6025
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health