Individual
RUSSELL A BOURNE JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1025 MILITARY TRL, SUITE 113, JUPITER, FL 33458-7040
(561) 748-2889
(561) 748-1523
Mailing address
35 OCEAN DR, TEQUESTA, FL 33469-3512
(561) 748-2889
(561) 748-1523
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY5579
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54097
BCBS
FL
Enumeration date
06/01/2006
Last updated
07/08/2007
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