Provider Demographics
NPI:1942220918
Name:BLISS, JO-ANNE (PSYD)
Entity type:Individual
Prefix:
First Name:JO-ANNE
Middle Name:
Last Name:BLISS
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 1:6830 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-5086
Mailing Address - Country:US
Mailing Address - Phone:954-584-6155
Mailing Address - Fax:954-316-7553
Practice Address - Street 1:6830 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-5086
Practice Address - Country:US
Practice Address - Phone:954-584-6155
Practice Address - Fax:954-316-7553
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766355200Medicaid