Healthcare Provider Details

I. General information

NPI: 1265376495
Provider Name (Legal Business Name): EMILY LUIS CIMINO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19032 CHEMILLE DR
LUTZ FL
33558-2842
US

IV. Provider business mailing address

19032 CHEMILLE DR
LUTZ FL
33558-2842
US

V. Phone/Fax

Practice location:
  • Phone: 813-362-3970
  • Fax: 813-362-3970
Mailing address:
  • Phone: 813-362-3970
  • Fax: 813-362-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: