Provider Demographics
NPI:1447014634
Name:MERVAR, JOAN (IMH24665)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:MERVAR
Suffix:
Gender:F
Credentials:IMH24665
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HIGHWAY 27 STE 4
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2411
Mailing Address - Country:US
Mailing Address - Phone:352-708-6283
Mailing Address - Fax:
Practice Address - Street 1:858 S DUNCAN DR STE 307
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4044
Practice Address - Country:US
Practice Address - Phone:352-708-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health