Provider Demographics
NPI:1568560274
Name:JANSON, PATRICIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:JANSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12214 ROCKLEDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4810
Mailing Address - Country:US
Mailing Address - Phone:561-488-1290
Mailing Address - Fax:561-488-1281
Practice Address - Street 1:7000 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 407
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3424
Practice Address - Country:US
Practice Address - Phone:561-347-0997
Practice Address - Fax:561-347-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73069AMedicare ID - Type UnspecifiedMEDICARE PROVIDER