MEDICARE: LUNA PSYCHOLOGICAL CARE, LLC

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

General Provider Information

NPI Number	:	1194510560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNA PSYCHOLOGICAL CARE, LLC

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	:	CLINICAL PSYCHOLOGIST
Name	:	DR. ESTEFANIA LUNA
Credential	:	PSYD
Telephone Number	:	954-305-2897

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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