Yulissa Fundora, LMHC, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY10407 Issued in FL

Practice address

11529 SW 13TH CT
Pembroke Pines, FL 33025-4811

Phone

(786) 378-0556

NPI assigned

Jun 7, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552608000000",
    "number": "1831419340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11529 SW 13TH CT",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330254811",
            "telephone_number": "786-378-0556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11529 SW 13TH CT",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330254811",
            "telephone_number": "786-378-0556"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15490 NW 7th Ave",
            "address_2": "Suite 202B",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331696250",
            "country_code": "US",
            "telephone_number": "305-685-4231 x1025",
            "fax_number": "305-685-4208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUNDORA",
        "first_name": "YULISSA",
        "credential": "LMHC, PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-07",
        "last_updated": "2019-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH11719",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY10407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.