Provider Demographics
NPI:1588069355
Name:BARDUN, LEE-ANNA
Entity type:Individual
Prefix:
First Name:LEE-ANNA
Middle Name:
Last Name:BARDUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 CORAL WAY STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1436
Mailing Address - Country:US
Mailing Address - Phone:786-648-4447
Mailing Address - Fax:
Practice Address - Street 1:7221 CORAL WAY STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1436
Practice Address - Country:US
Practice Address - Phone:786-648-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1700152101YP2500X
FLMH18384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional