Provider Demographics
NPI:1528380060
Name:ARDAVIN, PATRICIA MICHELLE (MS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MICHELLE
Last Name:ARDAVIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5254 NW 102ND CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-6607
Mailing Address - Country:US
Mailing Address - Phone:786-863-4053
Mailing Address - Fax:
Practice Address - Street 1:5254 NW 102ND CT
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-6607
Practice Address - Country:US
Practice Address - Phone:786-863-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH14631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001930800Medicaid
FL019610100Medicaid