Provider Demographics
NPI:1114973823
Name:EWING, AUBREY K (PHD)
Entity Type:Individual
Prefix:DR
First Name:AUBREY
Middle Name:K
Last Name:EWING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S FEDERAL HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6000
Mailing Address - Country:US
Mailing Address - Phone:561-742-7122
Mailing Address - Fax:561-742-7452
Practice Address - Street 1:1230 S FEDERAL HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6000
Practice Address - Country:US
Practice Address - Phone:561-742-7122
Practice Address - Fax:561-742-7452
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0000454101YP2500X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650436916OtherIRS EIN