Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 9177 | FL |
Y | 103TC0700X | Clinical Psychologist | 9177 | FL |
NPI | 1003299462 |
---|---|
Provider Name | Dr. Elizabeth Carmen Penela |
First Address | Weston, FL 33326-3206 |
Second Address | Weston, FL 33326-3206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 26/05/2020 |