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General NPI Number Information
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NPI Number | 1932213659
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Entity Type | Individual
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Provider Name | DOMINIQUE LILY MUSSELMAN MD, MSCR
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 1695 NW 9TH AVENUE, RM 2506 JACKSON MEMORIAL HOSPITAL, MENTAL HEALTH HOSPITAL CENTE
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City | MIAMI
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State | FL
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Zip | 33136-0001
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Country | US
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Telephone | 404-723-8361
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Fax |
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Provider Business Mailing Address
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Address Line | 1695 NW 9TH AVENUE, RM 2506 UNIVERSITY OF MIAMI DEPARTMENT OF PSYCHIATRY
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City | MIAMI
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State | FL
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Zip | 33136-0001
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Country | US
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Telephone | 404-723-8361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 108271
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 33653
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License Number State | GA
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