| Mindful Freedom Psychological Services Corp | |
|
2523 Herschel St Jacksonville FL 32204-4509 | |
| (786) 868-7017 | |
| Not Available |
| Full Name | Mindful Freedom Psychological Services Corp |
|---|---|
| Speciality | Psychologist |
| Location | 2523 Herschel St, Jacksonville, Florida |
| Authorized Official Name and Position | Laura Fernandez (OWNER/PROVIDER) |
| Authorized Official Contact | 7868687017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Freedom Psychological Services Corp 12418 Glenn Hollow Dr Jacksonville FL 32226-2361 Ph: (786) 868-7017 | Mindful Freedom Psychological Services Corp 2523 Herschel St Jacksonville FL 32204-4509 Ph: (786) 868-7017 |
| NPI Number | 1225745425 |
|---|---|
| Provider Enumeration Date | 10/28/2022 |
| Last Update Date | 05/08/2023 |
| Certification Date | 05/08/2023 |
| Medicare PECOS PAC ID | 7810360567 |
|---|---|
| Medicare Enrollment ID | O20230301000297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225745425 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Laura Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659880060 PECOS PAC ID: 7911263835 Enrollment ID: I20171109001680 |
| Provider Name | Nelsy Villalobos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003575176 PECOS PAC ID: 4385099662 Enrollment ID: I20231005002303 |
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