Healthcare Provider Details

I. General information

NPI: 1851435077
Provider Name (Legal Business Name): ROLAND F BESSIS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON ST STE 304
HOLLYWOOD FL
33021-8258
US

IV. Provider business mailing address

939 HOLLYWOOD BLVD
HOLLYWOOD FL
33019-1605
US

V. Phone/Fax

Practice location:
  • Phone: 954-961-1500
  • Fax: 954-961-7942
Mailing address:
  • Phone: 954-926-7486
  • Fax: 954-926-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0005053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: