Provider Demographics
NPI:1386925402
Name:DELISMA, GENEVIEVE P (MS IN EDLEADERSHIP)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:P
Last Name:DELISMA
Suffix:
Gender:F
Credentials:MS IN EDLEADERSHIP
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:PIERRE LOUIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS IN PSYCHOLOGY
Mailing Address - Street 1:14812 SW 171ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1778
Mailing Address - Country:US
Mailing Address - Phone:786-521-7721
Mailing Address - Fax:
Practice Address - Street 1:14812 SW 171ST TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-1778
Practice Address - Country:US
Practice Address - Phone:786-521-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2016-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist