Provider Demographics
NPI:1770506198
Name:ROWLEY, SALLY JOHNSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:JOHNSON
Last Name:ROWLEY
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 1:13262 SW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7917
Mailing Address - Country:US
Mailing Address - Phone:305-596-4663
Mailing Address - Fax:305-596-6847
Practice Address - Street 1:9150 SW 87TH AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2319
Practice Address - Country:US
Practice Address - Phone:305-596-4663
Practice Address - Fax:305-596-6947
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6227103TC0700X, 103TC2200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54699Medicare ID - Type UnspecifiedPROVIDER