| Abc | |
|
911 Columbus Ave Melbourne FL 32901-4605 | |
| (321) 622-3222 | |
| Not Available |
| Full Name | Abc |
|---|---|
| Speciality | Psychologist |
| Location | 911 Columbus Ave, Melbourne, Florida |
| Authorized Official Name and Position | Richard Bunt (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3216223222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abc 911 Columbus Ave Melbourne FL 32901-4605 Ph: (321) 622-3222 | Abc 911 Columbus Ave Melbourne FL 32901-4605 Ph: (321) 622-3222 |
| NPI Number | 1760772032 |
|---|---|
| Provider Enumeration Date | 04/07/2011 |
| Last Update Date | 05/19/2011 |
| Medicare PECOS PAC ID | 1759569106 |
|---|---|
| Medicare Enrollment ID | O20110707000155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760772032 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | ME98371 (Florida) | Primary |
| Provider Name | Richard Bunt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376619072 PECOS PAC ID: 3678465499 Enrollment ID: I20070817000003 |
| Provider Name | Renee M Breitenbach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366704124 PECOS PAC ID: 8628219771 Enrollment ID: I20130801000227 |
| Provider Name | Susan R Neil |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1831582378 PECOS PAC ID: 6305139601 Enrollment ID: I20160725001338 |
| Provider Name | Deborah L Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932498375 PECOS PAC ID: 3678751336 Enrollment ID: I20181025000241 |
| Provider Name | Stephanie P Eastman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992893549 PECOS PAC ID: 7719216225 Enrollment ID: I20190909003554 |
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