Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | D235540938430 | FL |
NPI | 1023516671 |
---|---|
Provider Name | Mical Destin |
First Address | Delray Beach, FL 33444-2273 |
Second Address | Delray Beach, FL 33444-2273 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2018 |
Last Update Date | 30/01/2018 |