Healthcare Provider Details

I. General information

NPI: 1962627950
Provider Name (Legal Business Name): MYRIAM GLEMAUD PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 S CONGRESS AVE
WEST PALM BEACH FL
33406-7608
US

IV. Provider business mailing address

1035 S STATE ROAD 7 SUITE 315-12
WELLINGTON FL
33414-6134
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-5849
  • Fax:
Mailing address:
  • Phone: 561-774-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7903
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8358
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: