Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY9326 | FL |
Y | 103T00000X | Psychologist | PY9326 | FL |
NPI | 1003286543 |
---|---|
Provider Name | Dr. Marcy Jaslow |
First Address | Ft Lauderdale, FL 33308-4034 |
Second Address | Ft Lauderdale, FL 33308-4034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2015 |
Last Update Date | 27/09/2015 |