MEDICARE: MS. ESTEFANIA LUNA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY.0006285	CO
2	103TC0700X	Clinical Psychologist	PS020366	PA

General Provider Information

NPI Number	:	1144734468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ESTEFANIA LUNA PSYD

Provider Business Mailing Address
First Line	:	4480 SW 122ND TER
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-3122
Country	:	US
Telephone Number	:	954-305-2897
Fax Number	:

Provider Business Practice Location Address
First Line	:	4743 SMICK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1909
Country	:	US
Telephone Number	:	954-305-2897
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2017
Last Update Date	:	04/12/2025

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