Organization
MICHAEL J. DITOMASSO PH.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN DITOMASSO PH.D (OWNER)
(305) 256-5610
Entity
Organization
Contact information
Practice address
13834 SW 122ND CT, MIAMI, FL 33186-6052
(305) 256-4324
(305) 256-5610
Mailing address
13834 SW 122ND CT, MIAMI, FL 33186-6052
(305) 256-4324
(305) 256-5610
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY 5449
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59897
BLUE CROSS PROVIDER NUMBE
FL
05
—
7672951
—
FL
Enumeration date
06/05/2007
Last updated
11/30/2009
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