Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | SS1056 | FL |
N | 1041C0700X | Clinical Social Worker | SW00004656 | FL |
NPI | 1063056695 |
---|---|
Provider Name | Kim Perez Schneider |
First Address | Riverview, FL 33578-2120 |
Second Address | Riverview, FL 33578-2120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2019 |
Last Update Date | 06/11/2019 |