Provider Demographics
NPI:1760790216
Name:EDGAR, VERONICA BORDES (PHD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:BORDES
Last Name:EDGAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:BORDES EDGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-0102
Mailing Address - Fax:214-645-1208
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-0102
Practice Address - Fax:214-645-1208
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX36857103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist