Provider Demographics
NPI:1154012326
Name:LLAVINA, ROBERTO (CBHCM)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:LLAVINA
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 ORLANDO CENTRAL PKWY STE 480
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5785
Mailing Address - Country:US
Mailing Address - Phone:407-382-9079
Mailing Address - Fax:407-964-1274
Practice Address - Street 1:1707 ORLANDO CENTRAL PKWY STE 480
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5785
Practice Address - Country:US
Practice Address - Phone:407-382-9079
Practice Address - Fax:407-964-1274
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM.0105934-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator