Provider Demographics
NPI:1811313430
Name:RAIMUNDI, IVELISSE MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:IVELISSE
Middle Name:MARIE
Last Name:RAIMUNDI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1200 BRICKELL BAY DR APT 3505
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3272
Mailing Address - Country:US
Mailing Address - Phone:305-653-5155
Mailing Address - Fax:305-653-5513
Practice Address - Street 1:2801 NW 87TH AVE UNIT 7
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1603
Practice Address - Country:US
Practice Address - Phone:787-587-6792
Practice Address - Fax:305-653-5513
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY8976103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist