Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY6113 | FL |
N | 103TC0700X | Clinical Psychologist | PY6113 | FL |
N | 103TH0004X | Health Psychologist | PY6113 | FL |
Y | 103TR0400X | Rehabilitation Psychologist | PY6113 | FL |
NPI | 1427275148 |
---|---|
Provider Name | Dr. Mario Olavarria |
First Address | Miami, FL 33173-3164 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 16/08/2016 |