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NPI Code Detail

MEDICARE: LEILA TERESITA CHARLEMAGNE PSYD

MEDICARE: LEILA TERESITA CHARLEMAGNE PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY7299FL
2103T00000XPsychologistPY 7299FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PY7299OTHERFLLICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134177330
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEILA TERESITA CHARLEMAGNE PSYD
Provider Business Mailing Address
First Line : 700 8TH AVE W STE 101
Second Line :
City : PALMETTO
State : FL
Zip : 34221-4737
Country : US
Telephone Number : 941-845-4905
Fax Number : 941-845-4963
Provider Business Practice Location Address
First Line : 3601 FEDERAL HWY
Second Line :
City : MIAMI
State : FL
Zip : 33137-3795
Country : US
Telephone Number : 305-567-6611
Fax Number : 305-576-0008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 02/16/2022

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Directions to “ LEILA TERESITA CHARLEMAGNE PSYD” Practice Location

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