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General NPI Number Information
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NPI Number | 1689431298
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Entity Type | Individual
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Provider Name | AMY ROSE HERTZBERG-MEADE LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1423 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-2801
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Country | US
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Telephone | 813-753-0866
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 KAY JEAN DR
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City | VALRICO
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State | FL
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Zip | 33594-4628
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Country | US
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Telephone | 813-597-9309
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH23171
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License Number State | FL
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