Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | IM18837 | FL |
NPI | 1023601754 |
---|---|
Provider Name | Mrs. Jacqueline Dorta |
First Address | Orlando, FL 32810-4466 |
Second Address | Orlando, FL 32810-4466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2021 |
Last Update Date | 13/02/2021 |