Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY 7397 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 7397 | FL |
Y | 103G00000X | Clinical Psychologist | PY 7397 | FL |
Y | 103TC0700X | Clinical Psychologist | PY 7397 | FL |
N | 103TF0000X | Family Psychologist | PY 7397 | FL |
N | 103TH0100X | Health Service | PY 7397 | FL |
N | 103TP2701X | Group Psychotherapist | PY 7397 | FL |
NPI | 1144294174 |
---|---|
Provider Name | Dr. Justin A D'arienzo |
First Address | Jacksonville, FL 32256-9682 |
Second Address | Jacksonville, FL 32256-9682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 13/03/2018 |