Healthcare Provider Details

I. General information

NPI: 1891759247
Provider Name (Legal Business Name): MARGIE MOLINET MOLINA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11520 SW 69TH CT
PINECREST FL
33156-4734
US

IV. Provider business mailing address

11520 SW 69TH CT
PINECREST FL
33156-4734
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-2549
  • Fax: 877-579-7427
Mailing address:
  • Phone: 305-669-2549
  • Fax: 877-579-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7041
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY7041
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY7041
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY7041
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPY7041
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS412
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7041
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: