Provider Demographics
NPI:1528175486
Name:MESA, RAMON D (PSYD LMHC)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:D
Last Name:MESA
Suffix:
Gender:M
Credentials:PSYD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 SW 20TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8017
Mailing Address - Country:US
Mailing Address - Phone:305-552-7008
Mailing Address - Fax:
Practice Address - Street 1:5753 MIAMI LAKES DR E
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2417
Practice Address - Country:US
Practice Address - Phone:305-403-0006
Practice Address - Fax:305-403-0007
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health