Provider Demographics
NPI:1205918547
Name:AGRESS, JOANN R (PHD)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:R
Last Name:AGRESS
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 1:20410 TALON TRCE
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3028
Mailing Address - Country:US
Mailing Address - Phone:239-776-1855
Mailing Address - Fax:239-567-5620
Practice Address - Street 1:2740 OAK RIDGE CT STE 304
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9371
Practice Address - Country:US
Practice Address - Phone:239-776-1855
Practice Address - Fax:239-567-5620
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0006587103G00000X, 103TH0100X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7719ZMedicare UPIN