Healthcare Provider Details

I. General information

NPI: 1639307119
Provider Name (Legal Business Name): PATRICIA RODRIGUEZ GILMORE L.M.H.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 SW 3RD AVE
MIAMI FL
33129-2300
US

IV. Provider business mailing address

2840 SW 3RD AVE
MIAMI FL
33129-2300
US

V. Phone/Fax

Practice location:
  • Phone: 305-857-0050
  • Fax: 305-854-4948
Mailing address:
  • Phone: 305-857-0050
  • Fax: 305-854-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8670
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: