Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY9960 | FL |
Y | 103T00000X | Psychologist | PSY9960 | FL |
N | 103G00000X | Clinical Psychologist | PSY9960 | FL |
N | 103TC0700X | Clinical Psychologist | PSY9960 | FL |
N | 103TH0004X | Health Psychologist | PSY9960 | FL |
NPI | 1467961243 |
---|---|
Provider Name | Cristina Callahan |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2017 |
Last Update Date | 21/02/2018 |