Healthcare Provider Details

I. General information

NPI: 1932459757
Provider Name (Legal Business Name): LAURA M PATRON PHD, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MAIN ST STE 102
WESTON FL
33326-3685
US

IV. Provider business mailing address

1840 MAIN ST STE 102
WESTON FL
33326-3685
US

V. Phone/Fax

Practice location:
  • Phone: 954-909-0199
  • Fax:
Mailing address:
  • Phone: 954-909-0199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH15925
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA49047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: