Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY9618 | FL |
NPI | 1124574595 |
---|---|
Provider Name | Mrs. Michelle C Fernandez |
First Address | South Miami, FL 33143 |
Second Address | South Miami, FL 33143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2016 |
Last Update Date | 17/09/2020 |