Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY11189 | FL |
N | 103T00000X | Psychologist | PY11189 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY11189 | FL |
Y | 103G00000X | Clinical Psychologist | PY11189 | FL |
Y | 103TC0700X | Clinical Psychologist | PY11189 | FL |
N | 103TP2701X | Group Psychotherapist | PY11189 | FL |
NPI | 1174289250 |
---|---|
Provider Name | Dr. Rebecca Conrad |
First Address | Tallahassee, FL 32303-7049 |
Second Address | Coral Springs, FL 33067-4640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2021 |
Last Update Date | 09/12/2021 |