Healthcare Provider Details

I. General information

NPI: 1962734525
Provider Name (Legal Business Name): HEIDI YOLANDA SPOSATO M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 KEATON PKWY
OCOEE FL
34761-4302
US

IV. Provider business mailing address

732 KEATON PKWY
OCOEE FL
34761-4302
US

V. Phone/Fax

Practice location:
  • Phone: 321-222-7107
  • Fax: 321-286-7844
Mailing address:
  • Phone: 321-222-7107
  • Fax: 321-286-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 3010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: