Healthcare Provider Details

I. General information

NPI: 1538151998
Provider Name (Legal Business Name): PATRICE GERARD PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 HIGH POINT RD MM88.5
TAVERNIER FL
33070-2006
US

IV. Provider business mailing address

119 W PLAZA DEL LAGO
ISLAMORADA FL
33036-4130
US

V. Phone/Fax

Practice location:
  • Phone: 305-852-3021
  • Fax:
Mailing address:
  • Phone: 305-664-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 5096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: