Provider Demographics
NPI:1043414147
Name:QUIROZ, ROBERTO FERNANDO (LMHC)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:FERNANDO
Last Name:QUIROZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2694
Mailing Address - Country:US
Mailing Address - Phone:352-686-3188
Mailing Address - Fax:
Practice Address - Street 1:3261 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2694
Practice Address - Country:US
Practice Address - Phone:352-686-3188
Practice Address - Fax:352-686-9394
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812121400Medicaid
FL765806100Medicaid
FLMH7627OtherLMHC
FL116600900Medicaid
FL000018400Medicaid