Provider Demographics
NPI:1730720475
Name:VAUGHAN, JOY (EDD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:JOY
Other - Middle Name:T
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:1230 NW 56TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6438
Mailing Address - Country:US
Mailing Address - Phone:786-209-3318
Mailing Address - Fax:
Practice Address - Street 1:1230 NW 56TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33313-6438
Practice Address - Country:US
Practice Address - Phone:786-209-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation