MEDICARE: DR. IVONNE EMILIA BAZERMAN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY5864	FL

General Provider Information

NPI Number	:	1861272064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVONNE EMILIA BAZERMAN PSY.D.

Provider Business Mailing Address
First Line	:	1499 S FEDERAL HWY UNIT 231
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6077
Country	:	US
Telephone Number	:	718-836-0245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 S FEDERAL HWY UNIT 231
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6077
Country	:	US
Telephone Number	:	718-836-0245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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