Provider Demographics
NPI:1316284565
Name:AMADOR, MABELIN ALTAGRACIA (MFT)
Entity type:Individual
Prefix:MISS
First Name:MABELIN
Middle Name:ALTAGRACIA
Last Name:AMADOR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:271 SW PALM DR APT 104
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1945
Mailing Address - Country:US
Mailing Address - Phone:772-985-5484
Mailing Address - Fax:863-357-8269
Practice Address - Street 1:306 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2565
Practice Address - Country:US
Practice Address - Phone:863-357-8268
Practice Address - Fax:863-357-8269
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor