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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
8637 SW 137TH AVE, MIAMI, FL 33183-4076
(305) 385-7409
Mailing address
4175 W 20TH AVE, HIALEAH, FL 33012-5874
(305) 825-0300

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY7541
FL

Other

Enumeration date
09/04/2007
Last updated
09/04/2007
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