MEDICARE: MS. TANYA DI GERONIMO LICENSED MENTAL HEAL

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 8636	FL

General Provider Information

NPI Number	:	1538125075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA DI GERONIMO LICENSED MENTAL HEAL

Provider Business Mailing Address
First Line	:	2307 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6708
Country	:	US
Telephone Number	:	754-236-3216
Fax Number	:

Provider Business Practice Location Address
First Line	:	2307 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-6708
Country	:	US
Telephone Number	:	754-236-3216
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	05/19/2026

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