Healthcare Provider Details

I. General information

NPI: 1396061800
Provider Name (Legal Business Name): PRINCE ROSARIO DRAGO L.M.H.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SW 37TH AVE 206
COCONUT GROVE FL
33133-2740
US

IV. Provider business mailing address

2780 S.W 37TH AVENUE 206
MIAMI FL
33133
US

V. Phone/Fax

Practice location:
  • Phone: 305-646-0112
  • Fax: 305-646-0113
Mailing address:
  • Phone: 305-646-0112
  • Fax: 305-646-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH4404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: