Provider Demographics
NPI:1013223874
Name:PEARSON, COLLEEN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:M
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2598 E SUNRISE BLVD STE 210A
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3230
Mailing Address - Country:US
Mailing Address - Phone:754-301-8739
Mailing Address - Fax:954-206-3005
Practice Address - Street 1:2598 E SUNRISE BLVD STE 210A
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3230
Practice Address - Country:US
Practice Address - Phone:754-301-8739
Practice Address - Fax:954-206-3005
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8769103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical