MEDICARE: GINA COBARRIS M.S.

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	101YM0800X	Mental Health Counselor	IMT1963	FL
2	101YS0200X	School Counselor	IMT1963	FL
3	106H00000X	Marriage & Family Therapist	IMT1963	FL

General Provider Information

NPI Number	:	1548683709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA COBARRIS M.S.

Provider Business Mailing Address
First Line	:	3300 W SOUTH ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-2322
Country	:	US
Telephone Number	:	407-963-3599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 W SOUTH ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-2322
Country	:	US
Telephone Number	:	407-963-3599
Fax Number	:

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

Provider Enumeration Date	:	01/23/2014
Last Update Date	:	01/23/2014

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Directions to “ GINA COBARRIS M.S.” Practice Location

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