Healthcare Provider Details

I. General information

NPI: 1528175486
Provider Name (Legal Business Name): RAMON D MESA PSY.D. LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5753 MIAMI LAKES DR E
MIAMI LAKES FL
33014-2417
US

IV. Provider business mailing address

9620 SW 20TH TER
MIAMI FL
33165-8017
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-0006
  • Fax: 305-403-0007
Mailing address:
  • Phone: 305-552-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: