Provider Demographics
NPI:1235964479
Name:ALMANZAR, PRIMAVERA DE JESUS (MA, RMHCI)
Entity type:Individual
Prefix:
First Name:PRIMAVERA
Middle Name:DE JESUS
Last Name:ALMANZAR
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:PRIMAVERA
Other - Middle Name:DE JESUS
Other - Last Name:ALMANZAR GARABITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, RMHCI
Mailing Address - Street 1:237 LOOKOUT PL
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8433
Mailing Address - Country:US
Mailing Address - Phone:407-801-4716
Mailing Address - Fax:321-203-2512
Practice Address - Street 1:237 LOOKOUT PL
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-8433
Practice Address - Country:US
Practice Address - Phone:407-801-4716
Practice Address - Fax:321-203-2512
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health