| NPI | 1376142463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YASMIN LUGO MORALES Program Director 321-325-0699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC1900X Psychologist Counseling | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TP0814X Psychologist Psychoanalysis | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |