Provider Demographics
NPI:1205629920
Name:BRETO FERNANDEZ, LORAIME
Entity type:Individual
Prefix:
First Name:LORAIME
Middle Name:
Last Name:BRETO FERNANDEZ
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 1:10513 WEEPING WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5125
Mailing Address - Country:US
Mailing Address - Phone:786-599-2706
Mailing Address - Fax:
Practice Address - Street 1:10513 WEEPING WILLOW PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5125
Practice Address - Country:US
Practice Address - Phone:786-599-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst