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General NPI Number Information
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NPI Number | 1982226171
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Entity Type | Organization
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Legal Business Name | MY SCHOOL PSYCHOLOGIST, INC
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Dates
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Enumeration Date | 05/11/2020
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 10300 SW 72ND ST STE 123
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City | MIAMI
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State | FL
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Zip | 33173-3001
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Country | US
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Telephone | 305-302-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 13101 SW 84TH ST
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City | MIAMI
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State | FL
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Zip | 33183-4323
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Country | US
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Telephone | 305-302-4776
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EVELYN THERESA CASTILLO-FUNDORA
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Credential | ED.S, LSP
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Telephone | 305-302-4776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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