Organization
BEHAVIORAL MIND WELLNESS: EVALUATION, PREVENTION & TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARMEN C CAPELLA PSYCHOLOGIST (LICENSED CLINICAL PSYCHOLOGIST)
(321) 888-6965
Entity
Organization
Contact information
Practice address
417 W VINE ST, KISSIMMEE, FL 34741-4154
(321) 888-6965
(407) 978-6520
Mailing address
417 W VINE ST, KISSIMMEE, FL 34741-4154
(321) 888-6965
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024947100
—
FL
Enumeration date
03/17/2020
Last updated
11/04/2021
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