Provider Demographics
NPI:1669401865
Name:BROGDON, LYNDA A (PHD,)
Entity type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:A
Last Name:BROGDON
Suffix:
Gender:F
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 KILLEARN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-3524
Mailing Address - Country:US
Mailing Address - Phone:850-893-8800
Mailing Address - Fax:850-893-6994
Practice Address - Street 1:2300 KILLEARN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3524
Practice Address - Country:US
Practice Address - Phone:850-893-8800
Practice Address - Fax:850-893-6994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4363103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73708OtherBLUE CROSS BLUE SHIELD