Provider Demographics
NPI:1912205220
Name:MORENO, ANA M (LMHC)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:MORENO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 SW 74TH ST
Mailing Address - Street 2:SUITE 407B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5165
Mailing Address - Country:US
Mailing Address - Phone:305-668-6417
Mailing Address - Fax:305-668-6418
Practice Address - Street 1:5901 SW 74TH ST
Practice Address - Street 2:SUITE 407B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5165
Practice Address - Country:US
Practice Address - Phone:305-668-6417
Practice Address - Fax:305-668-6418
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8568101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health