Healthcare Provider Details

I. General information

NPI: 1245548494
Provider Name (Legal Business Name): LETICIA CLARA CASADEMONT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 NW 17TH AVE
MIAMI FL
33125-1547
US

IV. Provider business mailing address

14345 NW 83RD PATH
MIAMI LAKES FL
33016-5724
US

V. Phone/Fax

Practice location:
  • Phone: 305-774-9570
  • Fax: 305-774-9573
Mailing address:
  • Phone: 305-582-6342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: