Provider Demographics
NPI:1366796435
Name:VIOLANTE, HEATHER ROBINSON (PSYD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROBINSON
Last Name:VIOLANTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 E COMMERCIAL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4042
Mailing Address - Country:US
Mailing Address - Phone:954-391-5305
Mailing Address - Fax:954-634-5360
Practice Address - Street 1:2419 E COMMERCIAL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4042
Practice Address - Country:US
Practice Address - Phone:954-391-5305
Practice Address - Fax:954-634-5360
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical