Provider Demographics
NPI:1588240824
Name:AVILES, ELIGIA (MA)
Entity type:Individual
Prefix:MRS
First Name:ELIGIA
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5132 OWLS CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8068
Mailing Address - Country:US
Mailing Address - Phone:561-758-1183
Mailing Address - Fax:
Practice Address - Street 1:15200 S JOG RD STE 303
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-1249
Practice Address - Country:US
Practice Address - Phone:561-758-1183
Practice Address - Fax:561-634-2776
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health