Healthcare Provider Details

I. General information

NPI: 1881809838
Provider Name (Legal Business Name): MARIAELENA PALOMINO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW 107TH AVE SUITE 109
SWEETWATER FL
33172-2732
US

IV. Provider business mailing address

8340 SW 105TH ST
MIAMI FL
33156-3564
US

V. Phone/Fax

Practice location:
  • Phone: 786-762-2952
  • Fax:
Mailing address:
  • Phone: 786-281-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 2132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: