Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY10455 | FL |
Y | 103T00000X | Psychologist | PY10455 | FL |
NPI | 1013460823 |
---|---|
Provider Name | Dr. Marisa Bermudez |
First Address | Fort Myers, FL 33907-5694 |
Second Address | Fort Myers, FL 33907-5694 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2016 |
Last Update Date | 12/07/2019 |