MEDICARE: MS. PAULA LOUISE PONCE M.A., 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	MH3273	FL

General Provider Information

NPI Number	:	1477601045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULA LOUISE PONCE M.A., L.M.H.C.

Provider Business Mailing Address
First Line	:	1514 SAN IGNACIO AVE
Second Line	:	STE 250
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3072
Country	:	US
Telephone Number	:	305-667-9910
Fax Number	:	305-446-9913

Provider Business Practice Location Address
First Line	:	1514 SAN IGNACIO AVE
Second Line	:	STE 250
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3072
Country	:	US
Telephone Number	:	305-667-9910
Fax Number	:	305-446-9913

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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