Provider Demographics
NPI:1154078921
Name:ESTRADA, EMILY ALYSSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ALYSSE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4119
Mailing Address - Country:US
Mailing Address - Phone:407-900-4885
Mailing Address - Fax:
Practice Address - Street 1:2521 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4119
Practice Address - Country:US
Practice Address - Phone:407-900-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007519103T00000X
FLPY11414103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist