Provider Demographics
NPI:1518338219
Name:GEORGIOU, LORETTA
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:
Last Name:GEORGIOU
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 1:2430 ESTANCIA BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2607
Mailing Address - Country:US
Mailing Address - Phone:727-460-6649
Mailing Address - Fax:
Practice Address - Street 1:2430 ESTANCIA BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2607
Practice Address - Country:US
Practice Address - Phone:727-460-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT 2255106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist