Provider Demographics
NPI:1508565763
Name:TOME PINO, CARMEN MARIA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIA
Last Name:TOME PINO
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 1:3150 STARBOARD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3785
Mailing Address - Country:US
Mailing Address - Phone:561-396-7345
Mailing Address - Fax:
Practice Address - Street 1:152 WEYBRIDGE CIR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1511
Practice Address - Country:US
Practice Address - Phone:561-788-4086
Practice Address - Fax:561-228-0540
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-247010106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician