Provider Demographics
NPI:1811936073
Name:WILKINSON, BERNEY J (PHD)
Entity type:Individual
Prefix:
First Name:BERNEY
Middle Name:J
Last Name:WILKINSON
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:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3515 E FLETCHER AVE
Practice Address - Street 2:MDC 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4706
Practice Address - Country:US
Practice Address - Phone:813-974-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7550103TS0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74327OtherBLUE CROSS BLUE SHIELD
FL74327OtherBLUE CROSS BLUE SHIELD