Provider Demographics
NPI:1174783161
Name:DAVID M HARVEY PHD P A
Entity type:Organization
Organization Name:DAVID M HARVEY PHD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MERIWETHER
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:904-280-1221
Mailing Address - Street 1:4400 MARSH LANDING BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-7215
Mailing Address - Country:US
Mailing Address - Phone:904-280-1221
Mailing Address - Fax:
Practice Address - Street 1:4400 MARSH LANDING BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-7215
Practice Address - Country:US
Practice Address - Phone:904-280-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK149OtherMEDICARE PTAN