Provider Demographics
NPI:1518107846
Name:BILL BRACKER PSYD PA
Entity Type:Organization
Organization Name:BILL BRACKER PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:9545-662-1166
Mailing Address - Street 1:915 MIDDLE RIVER DRIVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3560
Mailing Address - Country:US
Mailing Address - Phone:954-566-2166
Mailing Address - Fax:954-566-1186
Practice Address - Street 1:915 MIDDLE RIVER DRIVE
Practice Address - Street 2:SUITE 307
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3560
Practice Address - Country:US
Practice Address - Phone:954-566-2166
Practice Address - Fax:954-566-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0006LOtherBCBS
FL0006LOtherBCBS