Provider Demographics
NPI:1649478421
Name:HARRIS, PATRICIA ANN (MARRIAGE AND FAMILY)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MARRIAGE AND FAMILY
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3260 NW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311
Mailing Address - Country:US
Mailing Address - Phone:954-735-8721
Mailing Address - Fax:954-735-8721
Practice Address - Street 1:350 NW 70TH AVE
Practice Address - Street 2:SUITE A CHILD & FAMILY PSYCHOLOGISTS
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33331-2349
Practice Address - Country:US
Practice Address - Phone:954-587-7520
Practice Address - Fax:954-587-7527
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMFMT1574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist