MEDICARE: MS. DELIA JANICE LATORRE L.M.H.C.

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	101YM0800X	Mental Health Counselor	MH 11509	FL

General Provider Information

NPI Number	:	1457565715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DELIA JANICE LATORRE L.M.H.C.

Provider Business Mailing Address
First Line	:	1206 W. PLYMOUTH STREET
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603
Country	:	US
Telephone Number	:	813-245-2181
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5037
Country	:	US
Telephone Number	:	813-839-6700
Fax Number	:	813-835-1722

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	12/06/2012

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