Provider Demographics
NPI:1083171458
Name:CORONADO, DAVID D (PSY D, LMHC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:CORONADO
Suffix:
Gender:M
Credentials:PSY D, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2732
Mailing Address - Country:US
Mailing Address - Phone:786-762-2952
Mailing Address - Fax:
Practice Address - Street 1:722 TRADE WAY
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-8657
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:407-915-4387
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16244101YM0800X
FLPY12212103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16244Medicaid