Healthcare Provider Details

I. General information

NPI: 1083171458
Provider Name (Legal Business Name): DAVID D. CORONADO PSY. D., LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 TRADE WAY
SANFORD FL
32771-8657
US

IV. Provider business mailing address

1414 NW 107TH AVE
SWEETWATER FL
33172-2732
US

V. Phone/Fax

Practice location:
  • Phone: 833-769-3524
  • Fax: 407-915-4387
Mailing address:
  • Phone: 786-762-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16244
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12212
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY12212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: