MEDICARE: DR. COLLEEN M. PEARSON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY8769	FL

General Provider Information

NPI Number	:	1013223874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN M. PEARSON PSY.D.

Provider Business Mailing Address
First Line	:	2598 E SUNRISE BLVD STE 210A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3230
Country	:	US
Telephone Number	:	754-301-8739
Fax Number	:	954-206-3005

Provider Business Practice Location Address
First Line	:	2598 E SUNRISE BLVD STE 210A
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3230
Country	:	US
Telephone Number	:	754-301-8739
Fax Number	:	954-206-3005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	04/18/2022

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