| NPI | 1063953644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAINERY FUENTES Director 863-660-0218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY4076) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: FL PY4076) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |