Individual
JULISSA FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 VETERANS WAY, VIERA, FL 32940-8007
(321) 637-3788
Mailing address
4243 PALLADIAN WAY, MELBOURNE, FL 32904-1212
(321) 312-9844
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
10/28/2024
Last updated
10/28/2024
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