Provider Demographics
NPI:1598080996
Name:BOBB, ERNESTINE H (BAA)
Entity Type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:H
Last Name:BOBB
Suffix:
Gender:F
Credentials:BAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1172 NW 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-6620
Mailing Address - Country:US
Mailing Address - Phone:954-303-8622
Mailing Address - Fax:954-572-8231
Practice Address - Street 1:1172 NW 44TH AVE
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-6620
Practice Address - Country:US
Practice Address - Phone:954-303-8622
Practice Address - Fax:954-572-8231
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health