Provider Demographics
NPI:1912639063
Name:ORUE, ISIS (EDS, LSP, NCSP)
Entity type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:ORUE
Suffix:
Gender:F
Credentials:EDS, LSP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 SW FOUNTAINVIEW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4528
Mailing Address - Country:US
Mailing Address - Phone:772-332-3236
Mailing Address - Fax:
Practice Address - Street 1:7001 SW 97TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1410
Practice Address - Country:US
Practice Address - Phone:786-529-8378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1663103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool