Provider Demographics
NPI:1912541178
Name:HOLLY BEDOTTO, PSYD, LLC
Entity Type:Organization
Organization Name:HOLLY BEDOTTO, PSYD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BEDOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-571-8411
Mailing Address - Street 1:4770 BISCAYNE BLVD STE 780
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3232
Mailing Address - Country:US
Mailing Address - Phone:305-571-8411
Mailing Address - Fax:
Practice Address - Street 1:4770 BISCAYNE BLVD STE 780
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3232
Practice Address - Country:US
Practice Address - Phone:305-571-8411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty