Organization
DAVID M BORTNICK PHD PSY D PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID M BORTNICK PHD PSYD ABN (OWNER PRESIDENT)
(904) 392-1687
Entity
Organization
Contact information
Practice address
1750 TREE BLVD STE 5, ST AUGUSTINE, FL 32084-5719
(904) 342-0672
(904) 342-0673
Mailing address
PO BOX 3123, ST AUGUSTINE, FL 32085-3123
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PY2065
FL
Other
Enumeration date
03/31/2017
Last updated
01/06/2020
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