Provider Demographics
NPI:1801019963
Name:PEARCE, KATHY D (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:PEARCE
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 1:729 S APOLLO BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1457
Mailing Address - Country:US
Mailing Address - Phone:321-723-2330
Mailing Address - Fax:321-723-2330
Practice Address - Street 1:729 S APOLLO BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1457
Practice Address - Country:US
Practice Address - Phone:321-723-2330
Practice Address - Fax:321-723-2330
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical