Provider Demographics
NPI:1124249529
Name:CORONADO-PICALLO, BERKY (MS)
Entity type:Individual
Prefix:
First Name:BERKY
Middle Name:
Last Name:CORONADO-PICALLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 SW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1108
Mailing Address - Country:US
Mailing Address - Phone:305-221-9831
Mailing Address - Fax:
Practice Address - Street 1:9380 SW 72ND ST
Practice Address - Street 2:SUITE B-120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3276
Practice Address - Country:US
Practice Address - Phone:305-274-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH5410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health