Individual
DR. MARK IRA BORNSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
4310 METRO PKWY STE 205, FORT MYERS, FL 33916-9416
(239) 690-6906
Mailing address
4310 METRO PKWY STE 205, FORT MYERS, FL 33916-9416
(239) 690-6906
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY11422
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4932021
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
08/31/2006
Last updated
09/18/2025
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