MEDICARE: TATIANA GOROSPE M.ED, ED.S.

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	IMH25369	FL

General Provider Information

NPI Number	:	1750111886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA GOROSPE M.ED, ED.S.

Provider Business Mailing Address
First Line	:	8112 NEW JERSEY BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-2867
Country	:	US
Telephone Number	:	239-877-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	8112 NEW JERSEY BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33967-2867
Country	:	US
Telephone Number	:	239-877-3358
Fax Number	:

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

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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