Individual
MARTHA BOFILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
9801 NW 26TH ST, DORAL, FL 33172-1348
(786) 587-2617
Mailing address
9801 NW 26TH ST, DORAL, FL 33172-1348
(786) 587-2617
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY7089
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PY7089
STATE LICENSE
FL
Enumeration date
08/05/2007
Last updated
09/20/2007
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