Provider Demographics
NPI:1376797670
Name:KATHY D. PEARCE, PSY. D., PA
Entity Type:Organization
Organization Name:KATHY D. PEARCE, PSY. D., PA
Other - Org Name:BREVARD PSYCHOLOGY & LEARNING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:321-723-2300
Mailing Address - Street 1:729 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1457
Mailing Address - Country:US
Mailing Address - Phone:321-723-2330
Mailing Address - Fax:
Practice Address - Street 1:729 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1457
Practice Address - Country:US
Practice Address - Phone:321-723-2330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty