MEDICARE: CHRISTINA MARIE SONG

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	106H00000X	Marriage & Family Therapist	IMT3141	FL

General Provider Information

NPI Number	:	1609451970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA MARIE SONG

Provider Business Mailing Address
First Line	:	6051 PALM TRACE LANDINGS DR APT 307
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-1870
Country	:	US
Telephone Number	:	210-307-0393
Fax Number	:

Provider Business Practice Location Address
First Line	:	6051 PALM TRACE LANDINGS DR APT 307
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-1870
Country	:	US
Telephone Number	:	210-307-0393
Fax Number	:

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	03/09/2026

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