MEDICARE: DR. MARIA CHRISTINA MANDINA-DIMARCO PSYD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY10581	FL

General Provider Information

NPI Number	:	1932758323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA CHRISTINA MANDINA-DIMARCO PSYD

Provider Business Mailing Address
First Line	:	840 37TH PL STE 2
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6502
Country	:	US
Telephone Number	:	772-794-0179
Fax Number	:	772-794-1091

Provider Business Practice Location Address
First Line	:	840 37TH PL STE 2
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6502
Country	:	US
Telephone Number	:	772-794-0179
Fax Number	:	772-794-1091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	09/09/2019

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