Individual
JACQUELINE STEPHANIE HIDALGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY-D
Contact information
Practice address
2780 CLEVELAND AVE STE 709, FORT MYERS, FL 33901-5857
(239) 343-3831
(239) 343-2301
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-3831
(239) 343-2301
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY9966
FL
103TC0700X
Clinical Psychologist
PY9966
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100459600
—
FL
Enumeration date
08/23/2017
Last updated
03/25/2021
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