Basic Information
Provider Information | |||||||||
NPI: | 1487848347 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PARKER | ||||||||
FirstName: | PATRICIA | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MFT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 736 SE 32ND AVE | ||||||||
Address2: |   | ||||||||
City: | HOMESTEAD | ||||||||
State: | FL | ||||||||
PostalCode: | 330337248 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7867343660 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 654 NE 9TH PL | ||||||||
Address2: |   | ||||||||
City: | HOMESTEAD | ||||||||
State: | FL | ||||||||
PostalCode: | 330304934 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052483488 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/04/2007 | ||||||||
LastUpdateDate: | 09/15/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/15/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMT2676 | FL | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | IMT2676 | 01 | FL | FLORIDA DEPARTMENT OF HEALTH | OTHER |