Provider Demographics
NPI:1861882631
Name:LATINO LEADERSHIP, INC.
Entity type:Organization
Organization Name:LATINO LEADERSHIP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARUCCI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-895-0801
Mailing Address - Street 1:8617 E COLONIAL DR STE 1600
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-3937
Mailing Address - Country:US
Mailing Address - Phone:407-895-0801
Mailing Address - Fax:407-895-0803
Practice Address - Street 1:8617 E COLONIAL DR
Practice Address - Street 2:SUITE 1100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3938
Practice Address - Country:US
Practice Address - Phone:407-895-0801
Practice Address - Fax:407-895-0803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATINO LEADERSHIP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015526400Medicaid
FL015270300Medicaid
FL014503400Medicaid
FL017975600Medicaid