Provider Demographics
NPI:1972104420
Name:LATINO KIDS AND FAMILY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:LATINO KIDS AND FAMILY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERMINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:787-452-7173
Mailing Address - Street 1:11327 VILLAGE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7191
Mailing Address - Country:US
Mailing Address - Phone:787-452-7173
Mailing Address - Fax:
Practice Address - Street 1:11327 VILLAGE BROOK DRIVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579
Practice Address - Country:US
Practice Address - Phone:813-278-7644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty