Healthcare Provider Details

I. General information

NPI: 1255165254
Provider Name (Legal Business Name): SANDRA MONICA CASMIRO COUNSELOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 08/30/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 13TH ST
SAINT CLOUD FL
34769-4749
US

IV. Provider business mailing address

145 E 13TH ST
SAINT CLOUD FL
34769-4749
US

V. Phone/Fax

Practice location:
  • Phone: 407-749-3580
  • Fax:
Mailing address:
  • Phone: 407-749-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: