Provider Demographics
NPI:1992241046
Name:URBAEZ, ELLIEEM SORAYA
Entity type:Individual
Prefix:
First Name:ELLIEEM
Middle Name:SORAYA
Last Name:URBAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 SE 6TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5228
Mailing Address - Country:US
Mailing Address - Phone:305-230-6775
Mailing Address - Fax:
Practice Address - Street 1:2235 SE 6TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5228
Practice Address - Country:US
Practice Address - Phone:305-230-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106H00000X106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist