Provider Demographics
NPI:1982137139
Name:NEVILLE-FYFE, JUSTINE MARIE (EDS)
Entity Type:Individual
Prefix:MRS
First Name:JUSTINE
Middle Name:MARIE
Last Name:NEVILLE-FYFE
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 STARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5144
Mailing Address - Country:US
Mailing Address - Phone:561-254-1679
Mailing Address - Fax:
Practice Address - Street 1:2705 STARWOOD CT
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5144
Practice Address - Country:US
Practice Address - Phone:561-254-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 486103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool