Provider Demographics
NPI:1417064734
Name:TEPPERMAN, B. DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:B. DAWN
Middle Name:
Last Name:TEPPERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 RIO PINO N
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3732
Mailing Address - Country:US
Mailing Address - Phone:321-725-6835
Mailing Address - Fax:321-622-5403
Practice Address - Street 1:701 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4646
Practice Address - Country:US
Practice Address - Phone:321-725-6835
Practice Address - Fax:321-622-5403
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3400103TC0700X
FLMT383106H00000X
DCNAT10000593175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75974Medicare ID - Type Unspecified