Healthcare Provider Details

I. General information

NPI: 1003540667
Provider Name (Legal Business Name): AILEMA FERNANDEZ FRIGERIO PSYD, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SUNSET DR STE 140
MIAMI FL
33173-3038
US

IV. Provider business mailing address

10300 SUNSET DR STE 140
MIAMI FL
33173-3038
US

V. Phone/Fax

Practice location:
  • Phone: 305-505-1541
  • Fax:
Mailing address:
  • Phone: 305-302-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7792
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: