Provider Demographics
NPI:1063939981
Name:MURAI-PANIAGUA, IVETTE (LMHC)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:MURAI-PANIAGUA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4649 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2114
Mailing Address - Country:US
Mailing Address - Phone:786-280-5147
Mailing Address - Fax:
Practice Address - Street 1:505 TIBIDABO AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-6326
Practice Address - Country:US
Practice Address - Phone:786-280-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health