Provider Demographics
NPI:1972672293
Name:BICKNELL, ERNEST PAUL III (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:PAUL
Last Name:BICKNELL
Suffix:III
Gender:M
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:SYLVIA
Other - Middle Name:M
Other - Last Name:BICKNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFO
Mailing Address - Street 1:1890 S 14TH ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4740
Mailing Address - Country:US
Mailing Address - Phone:904-432-7833
Mailing Address - Fax:904-432-7831
Practice Address - Street 1:1890 S 14TH ST
Practice Address - Street 2:SUITE 306
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4740
Practice Address - Country:US
Practice Address - Phone:904-432-7833
Practice Address - Fax:904-432-7831
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
54601AMedicare ID - Type Unspecified