Provider Demographics
NPI:1710246665
Name:BHADHA, IVONA (LCSW)
Entity Type:Individual
Prefix:
First Name:IVONA
Middle Name:
Last Name:BHADHA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:IVONA
Other - Middle Name:
Other - Last Name:JANCICKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2721 MISTY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6809
Mailing Address - Country:US
Mailing Address - Phone:561-287-0942
Mailing Address - Fax:
Practice Address - Street 1:1900 S OLIVE AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-7726
Practice Address - Country:US
Practice Address - Phone:561-287-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 100401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW10040OtherSTATE LICENSE