Georgia Dare Bomgardner, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS019058 Issued in PA

Practice address

1 E Broad St Ste 510
Bethlehem, PA 18018-5964

Phone

(610) 865-4300

NPI assigned

Jul 23, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Center for Integrated Behavioral Health,LLC

  • Psychologist
  • Bethlehem, PA
  • NPI 1083981104
  NPD
• The Center for Mindfulness and CBT, LLC

  • Cognitive & Behavioral Psychologist
  • Saint Louis, MO
  • NPI 1154241271
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1568071785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 E WASHINGTON AVE",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180176043",
            "telephone_number": "901-230-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 E BROAD ST STE 510",
            "city": "BETHLEHEM",
            "state": "PA",
            "postal_code": "180185964",
            "telephone_number": "610-865-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMGARDNER",
        "first_name": "GEORGIA",
        "middle_name": "DARE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-23",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS019058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Rose Bold
• Linda Helen Boliver, P.T.A.
• Matthew Bollard, DO
• Beth I Bollinger, P.A.-C.
• Alisa Bolton
• Adele C Bon-Shannon, MSW LCSW
• Julia Bonanno, DO
• Cassandra Bond
• Hiram Antonio Bonilla
• Jose Bonilla

• Psychologist in Bethlehem, PA
• Providers in Bethlehem, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.