Provider Demographics
NPI:1417134578
Name:GARCIA LAWSON, KATHY ANN (PHD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:GARCIA LAWSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANN
Other - Last Name:GARCIA LAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2401 PGA BLVD
Mailing Address - Street 2:SUITE 128
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-694-2772
Mailing Address - Fax:561-691-1423
Practice Address - Street 1:2401 PGA BLVD
Practice Address - Street 2:SUITE 128
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-694-2772
Practice Address - Fax:561-691-1423
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSY5498103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54085Medicare PIN