Bonnie Slade PH.D. P.a.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PY002036 Issued in FL

Legal business name

BONNIE SLADE PH.D. P.A.

Practice address

1555 Port Malabar Blvd.
Suite 104
Palm Bay, FL 32958

Phone

(321) 729-0870

Fax

(321) 952-2516

NPI assigned

May 30, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Bonnie Slade, PH.D.

Title

President

Phone

(321) 729-0870

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sharon F. Pell, LCSW

  • Clinical Social Worker
  • Palm Bay, FL
  • NPI 1336148691
  NPD (past)
• William E. Riebsame, PH.D.

  • Health Service Psychologist
  • Palm Bay, FL
  • NPI 1215937826
  NPD (past)
• Doris Wolcott, MS, LMHC

  • Mental Health Counselor
  • Palm Bay, FL
  • NPI 1134128325
  NPD (past)

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

{
    "created_epoch": "1401408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401408000000",
    "number": "1629480231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 PORT MALABAR BLVD.",
            "address_2": "SUITE 104",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "32958",
            "telephone_number": "321-729-0870",
            "fax_number": "321-952-2516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 PORT MALABAR BLVD.",
            "address_2": "SUITE 104",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "32958",
            "telephone_number": "321-729-0870",
            "fax_number": "321-952-2516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNIE SLADE PH.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-30",
        "last_updated": "2014-05-30",
        "status": "A",
        "authorized_official_last_name": "SLADE",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-729-0870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY002036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blue Sky Behavioral Services, Inc
• Bluegrass Id Associated LLC
• BNC Cares, LLC
• Amanda N Body
• Patty Jean Bohr, PTA
• Boomers Victory Ventures
• Boppa'S Home
• Boppas Home
• Boppas Home 2
• Maria C Borrajo

• Clinical Child & Adolescent Psychologist in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Clinical Child & Adolescent Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2014; 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.