Basic Information
| Provider Information | |||||||||
| NPI: | 1811049182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAISONET-SOLER | ||||||||
| FirstName: | ERNESTO | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MA. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 E SAN SEBASTIAN CT | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327143020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876074395 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3201 BUDINGER AVE | ||||||||
| Address2: | |||||||||
| City: | ST. CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079102941 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | 2487 | PR | Y | Behavioral Health & Social Service Providers | Psychologist | 106H00000X | FL | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.