Healthcare Provider Details

I. General information

NPI: 1861882631
Provider Name (Legal Business Name): LATINO LEADERSHIP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8617 E COLONIAL DR SUITE 1100
ORLANDO FL
32817-3938
US

IV. Provider business mailing address

8617 E COLONIAL DR STE 1600
ORLANDO FL
32817-3937
US

V. Phone/Fax

Practice location:
  • Phone: 407-895-0801
  • Fax: 407-895-0803
Mailing address:
  • Phone: 407-895-0801
  • Fax: 407-895-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARUCCI GUZMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-895-0801