Provider Demographics
NPI:1386102929
Name:PEARL, ELISSA (LMFT)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:PEARL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 BROKEN SOUND PKWY NW STE 208
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3635
Mailing Address - Country:US
Mailing Address - Phone:561-632-0085
Mailing Address - Fax:
Practice Address - Street 1:851 BROKEN SOUND PKWY NW STE 208
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3635
Practice Address - Country:US
Practice Address - Phone:561-632-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UNKNOWNOtherUNKNOWN