MEDICARE: PEDIATRIC SPEECH SPECIALISTS & CLINICAL MENTAL HEALTH COUNSELING OF F

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
2	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780283861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC SPEECH SPECIALISTS & CLINICAL MENTAL HEALTH COUNSELING OF F

Provider Business Mailing Address
First Line	:	15120 MONTESINO DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6731
Country	:	US
Telephone Number	:	321-304-9289
Fax Number	:	321-326-1022

Provider Business Practice Location Address
First Line	:	15120 MONTESINO DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6731
Country	:	US
Telephone Number	:	321-304-9289
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LIDIA RAQUEL ROMERO MUNOZ
Credential	:	SLP
Telephone Number	:	321-304-9289

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	03/09/2026

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