Healthcare Provider Details

I. General information

NPI: 1396222469
Provider Name (Legal Business Name): MARCELA KITAIGORODSKY PSY.D. PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE
MIAMI FL
33136-1409
US

IV. Provider business mailing address

19993 NE 5TH CT
MIAMI FL
33179-3005
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-9028
  • Fax:
Mailing address:
  • Phone: 305-218-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY10193
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10193
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number10193
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: