Provider Demographics
NPI:1508846254
Name:ERNEST J BORDINI PHD & ASSOC PA
Entity Type:Organization
Organization Name:ERNEST J BORDINI PHD & ASSOC PA
Other - Org Name:CLINICAL PSYCHOLOGY ASSOC OF NORTH CENTRAL FLORIDA PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORDINI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-336-2888
Mailing Address - Street 1:2121 NW 40TH TER
Mailing Address - Street 2:STE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3570
Mailing Address - Country:US
Mailing Address - Phone:352-336-2888
Mailing Address - Fax:352-371-1730
Practice Address - Street 1:2121 NW 40TH TER
Practice Address - Street 2:STE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3570
Practice Address - Country:US
Practice Address - Phone:352-336-2888
Practice Address - Fax:352-371-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40173OtherBCBS
FL40173OtherBCBS