MEDICARE: AIDA L REDONDO 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	MPT93	FL
2	106H00000X	Marriage & Family Therapist	MFT00087	RI

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	:	1780710350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDA L REDONDO LMFT

Provider Business Mailing Address
First Line	:	1201 N HABANA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5210
Country	:	US
Telephone Number	:	813-870-0965
Fax Number	:	813-870-0965

Provider Business Practice Location Address
First Line	:	4023 N ARMENIA AVE
Second Line	:	SUITE 102
City	:	TAMPA
State	:	FL
Zip	:	33607-1017
Country	:	US
Telephone Number	:	401-835-8368
Fax Number	:	813-870-0965

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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Directions to “ AIDA L REDONDO LMFT” Practice Location

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