Provider Demographics
NPI:1336355684
Name:MAISONET, RAMON (MA)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:
Last Name:MAISONET
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:RAMON
Other - Middle Name:
Other - Last Name:MAISONET GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:7349 ULMERTON RD LOT 247
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4804
Mailing Address - Country:US
Mailing Address - Phone:787-607-6846
Mailing Address - Fax:
Practice Address - Street 1:4024 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETE
Practice Address - State:FL
Practice Address - Zip Code:33711-1239
Practice Address - Country:US
Practice Address - Phone:727-327-7656
Practice Address - Fax:727-322-2130
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1789103T00000X
FLMH21695103T00000X
FL21695101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM253720602590OtherDRIVERS LICENSE
PR1376OtherAPS
PR5197OtherINTERNATIONAL MED CARD