Provider Demographics
NPI:1083463210
Name:ACOSTA-CONDON, EMILY NICOLE (LMHC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:ACOSTA-CONDON
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 1:18834 CLOUD LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2127
Mailing Address - Country:US
Mailing Address - Phone:954-798-3775
Mailing Address - Fax:
Practice Address - Street 1:18834 CLOUD LAKE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2127
Practice Address - Country:US
Practice Address - Phone:954-798-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health