Provider Demographics
NPI:1992159271
Name:TRIVINO, MARIA DANIELA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:DANIELA
Last Name:TRIVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 CAPENDON AVE
Mailing Address - Street 2:APT. 301
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-7714
Mailing Address - Country:US
Mailing Address - Phone:305-924-2695
Mailing Address - Fax:
Practice Address - Street 1:1028 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1607
Practice Address - Country:US
Practice Address - Phone:407-720-4651
Practice Address - Fax:407-720-4690
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health