Provider Demographics
NPI:1871970418
Name:CATALINA JACOBS-FERNANDEZ, PSY.D. LLC
Entity type:Organization
Organization Name:CATALINA JACOBS-FERNANDEZ, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:ROSA
Authorized Official - Last Name:JACOBS-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-221-9921
Mailing Address - Street 1:11880 BIRD RD STE 219
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3574
Mailing Address - Country:US
Mailing Address - Phone:305-221-9921
Mailing Address - Fax:305-221-6731
Practice Address - Street 1:11880 BIRD RD STE 219
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3574
Practice Address - Country:US
Practice Address - Phone:305-221-9921
Practice Address - Fax:305-221-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS15433Medicare UPIN
FLZ3468Medicare PIN