Provider Demographics
NPI:1174029508
Name:BARDI, FREDERICK A
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:A
Last Name:BARDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 SW 77TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4512
Mailing Address - Country:US
Mailing Address - Phone:786-312-6929
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:6720 SW 77TH TER
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4512
Practice Address - Country:US
Practice Address - Phone:786-312-6929
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician