Basic Information
| Provider Information | |||||||||
| NPI: | 1689880668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMIREZ | ||||||||
| FirstName: | TANIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9418 SW 225TH ST | ||||||||
| Address2: | |||||||||
| City: | CUTLER BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331901796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055582480 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9418 SW 225TH ST | ||||||||
| Address2: | |||||||||
| City: | CUTLER BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331901796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055582480 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 03/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | IMT678 | 01 | FL | REGISTERED MFT THERAPIST | OTHER | 017836000 | 05 | FL | MEDICAID |