Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | FL |
NPI | 1235403304 |
---|---|
Provider Name | Aida Maria Custode |
First Address | Miami, FL 33186-2122 |
Second Address | Sunrise, FL 33325-6236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2012 |
Last Update Date | 06/03/2012 |