Provider Demographics
NPI:1861272064
Name:BAZERMAN, IVONNE EMILIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:EMILIA
Last Name:BAZERMAN
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 1:1499 S FEDERAL HWY UNIT 231
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6077
Mailing Address - Country:US
Mailing Address - Phone:718-836-0245
Mailing Address - Fax:
Practice Address - Street 1:1499 S FEDERAL HWY UNIT 231
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-6077
Practice Address - Country:US
Practice Address - Phone:718-836-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5864103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical