Provider Demographics
NPI:1275286072
Name:PERSAD-TAPIA, NEETU (RMFTI)
Entity Type:Individual
Prefix:
First Name:NEETU
Middle Name:
Last Name:PERSAD-TAPIA
Suffix:
Gender:F
Credentials:RMFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S SEMORAN BLVD STE 1049
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5512
Mailing Address - Country:US
Mailing Address - Phone:321-972-1875
Mailing Address - Fax:
Practice Address - Street 1:1035 S SEMORAN BLVD STE 1049
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5512
Practice Address - Country:US
Practice Address - Phone:321-972-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3309106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIMT3309OtherSTATE OF FLORIDA