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Individual

DR. LOURDES PORTALES DALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHD

Contact information

Practice address
580 W 8TH ST FL TOWERII6, JACKSONVILLE, FL 32209-6533
(860) 305-2908
Mailing address
830-13 A1A NORTH, #690, PONTE VEDRA BEACH, FL 32082
(860) 305-2908

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
002436
CT
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
10538
FL

Other

Enumeration date
06/18/2020
Last updated
06/18/2020
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