Provider Demographics
NPI:1851435077
Name:BESSIS, ROLAND F (PHD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:F
Last Name:BESSIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-1605
Mailing Address - Country:US
Mailing Address - Phone:954-926-7486
Mailing Address - Fax:954-926-5804
Practice Address - Street 1:3700 WASHINGTON ST STE 304
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8258
Practice Address - Country:US
Practice Address - Phone:954-961-1500
Practice Address - Fax:954-961-7942
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005053103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59678Medicare ID - Type UnspecifiedROLAND BESSIS PHD