Provider Demographics
NPI:1982899282
Name:LONDONO, JULIAN ADOLFO (MFT)
Entity type:Individual
Prefix:MR
First Name:JULIAN
Middle Name:ADOLFO
Last Name:LONDONO
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8730 SW 133RD AVENUE RD
Mailing Address - Street 2:APT. #317
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5385
Mailing Address - Country:US
Mailing Address - Phone:305-281-2963
Mailing Address - Fax:305-235-6178
Practice Address - Street 1:8730 SW 133RD AVENUE RD
Practice Address - Street 2:APT. #317
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5385
Practice Address - Country:US
Practice Address - Phone:305-281-2963
Practice Address - Fax:305-235-6178
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768598000Medicaid