Provider Information for 1831314483
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ROSE MARY LAGRAVERE LMHC
Sex: Female
NPI: 1831314483
Last Updated: 2019-07-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1831314483 | ||||||||||||||
| Enumeration Date | 2007-04-16 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 12469 SW 124TH ST MIAMI, FL 33186-9015 United States Phone: 786-486-6279 | Fax: | ||||||||||||||
| Primary Practice Address | 12469 SW 124TH ST MIAMI, FL 33186-9015 United States Phone: 786-486-6279 | Fax: | ||||||||||||||
| Secondary Practice Address(es) | 9380 SW 72 ST. | ||||||||||||||
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