Provider Demographics
NPI:1053470013
Name:GURVIT, JESSICA M (PSY D)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
Last Name:GURVIT
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 NE 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2419
Mailing Address - Country:US
Mailing Address - Phone:954-764-7155
Mailing Address - Fax:954-764-6083
Practice Address - Street 1:514 SE 11 COURT
Practice Address - Street 2:SUITE A
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-764-7155
Practice Address - Fax:954-764-6083
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5752103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54237Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER