Provider Demographics
NPI:1821215666
Name:HARRIS, GINA MELANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MELANIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:19195 MYSTIC POINTE DR APT 1701 BLDG 100
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-4507
Mailing Address - Country:US
Mailing Address - Phone:954-966-4447
Mailing Address - Fax:305-936-0005
Practice Address - Street 1:19195 MYSTIC POINTE DR APT 1701 BLDG 100
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-4507
Practice Address - Country:US
Practice Address - Phone:954-966-4447
Practice Address - Fax:305-936-0005
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPY0003194103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist