Provider Demographics
NPI:1902277171
Name:BROOME-LEVINUS, MARIA VICTORIA (MS IN EARLY CHILDH)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:VICTORIA
Last Name:BROOME-LEVINUS
Suffix:
Gender:F
Credentials:MS IN EARLY CHILDH
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:VICTORIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:705 WEST DEER LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-7201
Mailing Address - Country:US
Mailing Address - Phone:813-948-7934
Mailing Address - Fax:813-948-7934
Practice Address - Street 1:705 WEST DEER LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-7201
Practice Address - Country:US
Practice Address - Phone:813-948-7934
Practice Address - Fax:813-948-7934
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency