Provider Demographics
NPI:1083171458
Name:CORONADO, DAVID (LMHC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:CORONADO
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 1:1414 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2732
Mailing Address - Country:US
Mailing Address - Phone:786-762-2952
Mailing Address - Fax:
Practice Address - Street 1:734 STIRLING CENTER PL
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4856
Practice Address - Country:US
Practice Address - Phone:407-537-9453
Practice Address - Fax:407-578-6663
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16244101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16244Medicaid