| Latino Kids And Family Mental Health Llc | |
|
11327 Village Brook Drive Riverview FL 33579 | |
| (813) 278-7644 | |
| Not Available |
| Full Name | Latino Kids And Family Mental Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 11327 Village Brook Drive, Riverview, Florida |
| Authorized Official Name and Position | Fermina L Roman (OWNER) |
| Authorized Official Contact | 7874527173 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Latino Kids And Family Mental Health Llc 11327 Village Brook Dr Riverview FL 33579-7191 Ph: (787) 452-7173 | Latino Kids And Family Mental Health Llc 11327 Village Brook Drive Riverview FL 33579 Ph: (813) 278-7644 |
| NPI Number | 1972104420 |
|---|---|
| Provider Enumeration Date | 11/02/2020 |
| Last Update Date | 11/04/2020 |
| Certification Date | 11/03/2020 |
| Medicare PECOS PAC ID | 7719363373 |
|---|---|
| Medicare Enrollment ID | O20221005000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972104420 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Fermina Roman |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1922339787 PECOS PAC ID: 7618163320 Enrollment ID: I20221005000553 |
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