MEDICARE: MARIE-CLAUDE ERGENER PH.D.

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
1	103TC0700X	Clinical Psychologist	8509	FL

General Provider Information

NPI Number	:	1538155536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE-CLAUDE ERGENER PH.D.

Provider Business Mailing Address
First Line	:	1450 MADRUGA AVE STE 310
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3164
Country	:	US
Telephone Number	:	973-650-9650
Fax Number	:	305-663-5809

Provider Business Practice Location Address
First Line	:	1450 MADRUGA AVE STE 310
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-3164
Country	:	US
Telephone Number	:	908-273-7269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2005
Last Update Date	:	05/01/2018

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