Healthcare Provider Details

I. General information

NPI: 1093835761
Provider Name (Legal Business Name): MICHELLE RENEE HINTZ PSYD, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD SUITE 400
HOLLYWOOD FL
33021-6917
US

IV. Provider business mailing address

450 N PARK RD SUITE 400
HOLLYWOOD FL
33021-6917
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax: 954-925-3193
Mailing address:
  • Phone: 954-925-3191
  • Fax: 954-925-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY7496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: