Provider Demographics
NPI:1558414565
Name:BIELEK, DAGMAR TAMARA (PHD)
Entity Type:Individual
Prefix:
First Name:DAGMAR
Middle Name:TAMARA
Last Name:BIELEK
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 1:1431 CAPRI LN
Mailing Address - Street 2:APT. 5209
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-4010
Mailing Address - Country:US
Mailing Address - Phone:954-349-3892
Mailing Address - Fax:954-349-3892
Practice Address - Street 1:1431 CAPRI LN
Practice Address - Street 2:APT. 5209
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4010
Practice Address - Country:US
Practice Address - Phone:954-349-3892
Practice Address - Fax:954-349-3892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54629Medicare ID - Type UnspecifiedPROVIDER NUMBER