Provider Demographics
NPI:1881809838
Name:PALOMINO, MARIAELENA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:MARIAELENA
Middle Name:
Last Name:PALOMINO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 SW 105TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3564
Mailing Address - Country:US
Mailing Address - Phone:786-281-8855
Mailing Address - Fax:
Practice Address - Street 1:1414 NW 107TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2732
Practice Address - Country:US
Practice Address - Phone:786-762-2952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2132106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003324000Medicaid