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General NPI Number Information
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NPI Number | 1811764707
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Entity Type | Individual
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Provider Name | MONICA MAEDA
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Gender | Female
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 397 WEKIVA SPRINGS RD STE 205
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City | LONGWOOD
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State | FL
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Zip | 32779-3697
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Country | US
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Telephone | 407-405-3257
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Fax |
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Provider Business Mailing Address
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Address Line | 156 LAGO VISTA BLVD
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City | CASSELBERRY
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State | FL
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Zip | 32707-5871
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Country | US
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Telephone | 407-421-6009
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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 | IMH24964
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License Number State | FL
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