MEDICARE: MRS. CYNTHIA BAEMI BOCANEGRA 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	MH10506	FL
2	101YP2500X	Professional Counselor	MH10506	FL

General Provider Information

NPI Number	:	1588966808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA BAEMI BOCANEGRA L.M.H.C.

Provider Business Mailing Address
First Line	:	1277 N SEMORAN BLVD
Second Line	:	SUITE 107
City	:	ORLANDO
State	:	FL
Zip	:	32807-3569
Country	:	US
Telephone Number	:	407-601-7748
Fax Number	:	407-601-7749

Provider Business Practice Location Address
First Line	:	1277 N SEMORAN BLVD
Second Line	:	SUITE 107
City	:	ORLANDO
State	:	FL
Zip	:	32807-3569
Country	:	US
Telephone Number	:	407-601-7748
Fax Number	:	407-601-7749

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

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	11/18/2010

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