Provider Demographics
NPI:1962771832
Name:JELU, MARISA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:M
Last Name:JELU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8874 W FLAGLER ST
Mailing Address - Street 2:APT. 105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3982
Mailing Address - Country:US
Mailing Address - Phone:305-853-6282
Mailing Address - Fax:
Practice Address - Street 1:8785 SW 165TH AVE
Practice Address - Street 2:SUITE #106-C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5826
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:786-206-4702
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4129103TC0700X, 101YM0800X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health