Doctor Name: | DR. JOHN MANUEL BERMUDEZ |
NPI Number: | 1083779847 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 643 |
Business Practice Address: | 2930 Austin Bluffs Pkwy Suite 102 Colorado Springs, CO - 809185763 |
Business Phone Number: | 7195949997 |
Business Fax Number: | 7195944152 |
Mailing Address: | 2930 Austin Bluffs Pkwy, Suite 102 COLORADO SPRINGS |
State: | CO |
Postal Code: | 809185763 |
Phone Number: | 7195949997 |
Fax Number: | 7195944152 |
NPI Enumeration Date: | 12/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 643 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |