MEDICARE: DYNAMIC PSYCHOMETRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center
3	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PY9007	OTHER	FL	PSYCHOLOGY LICENSE

General Provider Information

NPI Number	:	1710528237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC PSYCHOMETRICS LLC

Provider Business Mailing Address
First Line	:	13361 N 56TH ST OFC B
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-1161
Country	:	US
Telephone Number	:	727-279-5878
Fax Number	:	833-720-9866

Provider Business Practice Location Address
First Line	:	13361 N 56TH ST OFC B
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-1161
Country	:	US
Telephone Number	:	727-279-5878
Fax Number	:	833-720-9866

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARIA EMIL JIMENEZ
Credential	:	PSY. D.
Telephone Number	:	813-503-3652

Provider Enumeration Date	:	10/06/2019
Last Update Date	:	04/21/2021

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