Individual
MICHELLE MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D
Contact information
Practice address
4175 W 20TH AVE, HIALEAH, FL 33012-5874
(305) 825-0300
Mailing address
14132 SW 52ND LN, MIRAMAR, FL 33027-5981
(786) 863-1948
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY8859
FL
Other
Enumeration date
09/18/2013
Last updated
03/22/2017
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