Provider Demographics
NPI:1790834000
Name:HARRIS, CYNTHIA POLLANS (PHD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:POLLANS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 PETERS RD
Mailing Address - Street 2:SUITE D106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4038
Mailing Address - Country:US
Mailing Address - Phone:954-475-9503
Mailing Address - Fax:954-476-2369
Practice Address - Street 1:8030 PETERS RD
Practice Address - Street 2:SUITE D106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4038
Practice Address - Country:US
Practice Address - Phone:954-475-9503
Practice Address - Fax:954-476-2369
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003936103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592838700Medicare UPIN
FL73542Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER