Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PY5078 | FL |
N | 103T00000X | Psychologist | PY5078 | FL |
Y | 103G00000X | Clinical Psychologist | PY5078 | FL |
Y | 103TC0700X | Clinical Psychologist | PY5078 | FL |
N | 103TC1900X | Counseling Psychologist | PY5078 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY5078 | FL |
NPI | 1124016621 |
---|---|
Provider Name | Gerarda Desanto |
First Address | Tamarac, FL 33321-5093 |
Second Address | Tamarac, FL 33321-5093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 24/03/2011 |