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General NPI Number Information
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NPI Number | 1952784225
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Entity Type | Organization
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Legal Business Name | CARMEN CORNIDE, PSY.D., P.A.
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 1601 N PALM AVE SUITE 300
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3200
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Country | US
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Telephone | 954-443-0018
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Fax | 954-236-6331
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Provider Business Mailing Address
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Address Line | 1601 N PALM AVE SUITE 300
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3200
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Country | US
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Telephone | 954-443-0018
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Fax | 954-236-6331
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARMEN CORNIDE
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Credential | PSY.D.
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Telephone | 954-443-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY5595
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License Number State | FL
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