Healthcare Provider Details

I. General information

NPI: 1932331915
Provider Name (Legal Business Name): ELIZABETH YOLANDA SKJOLDAL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 12/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 SW 137TH AVE STE 225
MIAMI FL
33186-1432
US

IV. Provider business mailing address

9020 SW 137TH AVE STE 225
MIAMI FL
33186-1432
US

V. Phone/Fax

Practice location:
  • Phone: 786-379-4466
  • Fax: 305-363-5957
Mailing address:
  • Phone: 786-379-4466
  • Fax: 305-363-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY4936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: