Provider Demographics
NPI:1972749927
Name:SOTELO, CARMEN LUZ (MS)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LUZ
Last Name:SOTELO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18999 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2814
Mailing Address - Country:US
Mailing Address - Phone:305-933-9820
Mailing Address - Fax:
Practice Address - Street 1:18999 BISCAYNE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2814
Practice Address - Country:US
Practice Address - Phone:305-933-9820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 6597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health