MEDICARE: MRS. DOLORES B GROHMANN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT 1891	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144378555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DOLORES B GROHMANN LMFT

Provider Business Mailing Address
First Line	:	4929 VAN DYKE RD.
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558
Country	:	US
Telephone Number	:	813-924-3491
Fax Number	:	813-961-5919

Provider Business Practice Location Address
First Line	:	4322 SOUTHPARK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-3417
Country	:	US
Telephone Number	:	813-265-1105
Fax Number	:	813-961-4406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	09/24/2010

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