Healthcare Provider Details

I. General information

NPI: 1356026330
Provider Name (Legal Business Name): JOCELYN MICHELE LEGASPI BUHAIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 JAMERSON PL
ORLANDO FL
32807-1020
US

IV. Provider business mailing address

4526 JAMERSON PL
ORLANDO FL
32807-1020
US

V. Phone/Fax

Practice location:
  • Phone: 321-279-5415
  • Fax:
Mailing address:
  • Phone: 321-279-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3333
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY7709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: