Healthcare Provider Details

I. General information

NPI: 1144889833
Provider Name (Legal Business Name): JESSICA MARIE CUADROS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 E CONCORD ST
ORLANDO FL
32803-5453
US

IV. Provider business mailing address

4726 NEW BROAD ST APT 305
ORLANDO FL
32814-6426
US

V. Phone/Fax

Practice location:
  • Phone: 305-793-7174
  • Fax:
Mailing address:
  • Phone: 305-793-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12188
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: