Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH13681 | FL |
N | 103TC1900X | Counseling Psychologist |
NPI | 1083236343 |
---|---|
Provider Name | Dr. Marie Dezelic |
First Address | Coral Gables, FL 33134-5832 |
Second Address | Coral Gables, FL 33134-5832 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2020 |
Last Update Date | 10/05/2020 |