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General NPI Number Information
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NPI Number | 1972104420
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Entity Type | Organization
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Legal Business Name | LATINO KIDS AND FAMILY MENTAL HEALTH LLC
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 11327 VILLAGE BROOK DRIVE
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City | RIVERVIEW
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State | FL
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Zip | 33579
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Country | US
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Telephone | 813-278-7644
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Fax |
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Provider Business Mailing Address
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Address Line | 11327 VILLAGE BROOK DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-7191
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Country | US
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Telephone | 787-452-7173
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FERMINA L ROMAN
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Credential | LMHC
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Telephone | 787-452-7173
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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 |
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License Number State |
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