Provider Demographics
NPI:1104398551
Name:PATRICIA MARIE CORDARY HARTNETT PSY.D.,L.L.C.
Entity Type:Organization
Organization Name:PATRICIA MARIE CORDARY HARTNETT PSY.D.,L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSY
Authorized Official - Phone:954-638-8615
Mailing Address - Street 1:12555 ORANGE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4304
Mailing Address - Country:US
Mailing Address - Phone:954-416-1781
Mailing Address - Fax:954-239-3902
Practice Address - Street 1:12555 ORANGE DR STE 104
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4304
Practice Address - Country:US
Practice Address - Phone:954-416-1781
Practice Address - Fax:954-239-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002138000Medicaid