Provider Demographics
NPI:1124174594
Name:BEDOTTO, HOLLY ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANNE
Last Name:BEDOTTO
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 1:3050 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137
Mailing Address - Country:US
Mailing Address - Phone:305-571-8411
Mailing Address - Fax:305-571-8412
Practice Address - Street 1:3050 BISCAYNE BLVD
Practice Address - Street 2:SUITE 1005
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-571-8411
Practice Address - Fax:305-571-8412
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54537Medicare ID - Type Unspecified