Healthcare Provider Details

I. General information

NPI: 1417497876
Provider Name (Legal Business Name): ELISA KATIA MORITZ-RUBENSTEIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 N COMMERCE PKWY SUITE 3
WESTON FL
33326-3252
US

IV. Provider business mailing address

2233 N COMMERCE PKWY SUITE 3
WESTON FL
33326-3252
US

V. Phone/Fax

Practice location:
  • Phone: 954-217-1757
  • Fax:
Mailing address:
  • Phone: 954-217-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY 5997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: