Provider Demographics
NPI:1215295068
Name:NODAL, IDALMIS (LMHC)
Entity type:Individual
Prefix:
First Name:IDALMIS
Middle Name:
Last Name:NODAL
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 1:15630 SW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2524
Mailing Address - Country:US
Mailing Address - Phone:786-247-6496
Mailing Address - Fax:305-383-3296
Practice Address - Street 1:9600 SW 8TH ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2900
Practice Address - Country:US
Practice Address - Phone:305-559-8838
Practice Address - Fax:305-559-6608
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9656101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health