Healthcare Provider Details

I. General information

NPI: 1639986268
Provider Name (Legal Business Name): REGINA ESPARZA HERMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 BELL TOWER LN STE 201
WESTON FL
33326-3644
US

IV. Provider business mailing address

1760 BELL TOWER LN STE 201
WESTON FL
33326-3644
US

V. Phone/Fax

Practice location:
  • Phone: 559-681-8275
  • Fax:
Mailing address:
  • Phone: 559-681-8275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: