Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
N | 104100000X | Social Worker | ||
N | 225700000X | Massage Therapist | ||
N | 225C00000X | Rehabilitation Counselor | ||
N | 225X00000X | Occupational Therapist |
NPI | 1336315191 |
---|---|
Provider Name | Ms. Ingrid Michelle Fonseca |
First Address | West Palm Beach, FL 33405-2380 |
Second Address | West Palm Beach, FL 33405-2380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2008 |
Last Update Date | 01/05/2008 |