Provider Demographics
NPI:1568683555
Name:FAITH S SPERRY PSY D PA
Entity Type:Organization
Organization Name:FAITH S SPERRY PSY D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-327-8999
Mailing Address - Street 1:2787 E OAKLAND PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1630
Mailing Address - Country:US
Mailing Address - Phone:954-327-8999
Mailing Address - Fax:954-565-6178
Practice Address - Street 1:2787 E OAKLAND PARK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1630
Practice Address - Country:US
Practice Address - Phone:954-327-8999
Practice Address - Fax:954-565-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73601Medicare ID - Type Unspecified