Provider Demographics
NPI:1063742369
Name:BEJNAR, ALICE (MSW)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:
Last Name:BEJNAR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2354 MOON DANCE TRL
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-9007
Mailing Address - Country:US
Mailing Address - Phone:850-509-5968
Mailing Address - Fax:850-921-0238
Practice Address - Street 1:2354 MOON DANCE TRL
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-9007
Practice Address - Country:US
Practice Address - Phone:850-509-5968
Practice Address - Fax:850-921-0238
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL752014000Medicaid