Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 10193 | FL |
Y | 103TC0700X | Clinical Psychologist | 10193 | FL |
N | 103TR0400X | Rehabilitation Psychologist | 10193 | FL |
NPI | 1396222469 |
---|---|
Provider Name | Mrs. Marcela Kitaigorodsky |
First Address | Miami, FL 33179-3005 |
Second Address | Miami, FL 33136-1409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 23/07/2018 |