Provider Demographics
NPI:1972564664
Name:COELLO-JEMMALI, ELENA C (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:C
Last Name:COELLO-JEMMALI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9729 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2806
Mailing Address - Country:US
Mailing Address - Phone:305-740-3038
Mailing Address - Fax:305-740-3038
Practice Address - Street 1:9729 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2806
Practice Address - Country:US
Practice Address - Phone:305-740-3038
Practice Address - Fax:305-740-3038
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0TH00Medicare UPIN
FLK8571Medicare ID - Type Unspecified