Provider Demographics
NPI:1154772945
Name:ALONSO, IVETTE (LMHC)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:ALONSO
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 1:13105 SW 2ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1255
Mailing Address - Country:US
Mailing Address - Phone:786-326-3513
Mailing Address - Fax:
Practice Address - Street 1:6405 NW 36TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6974
Practice Address - Country:US
Practice Address - Phone:305-871-3131
Practice Address - Fax:305-871-2727
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10783101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health