Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | ||
N | 103TC0700X | Clinical Psychologist | ||
Y | 102L00000X | Psychologist | PY5159 | FL |
Y | 103T00000X | Psychologist | PY5159 | FL |
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TF0200X | Forensic Psychologist | PY5159 | FL |
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1164620969 |
---|---|
Provider Name | Dr. Bruce Glenn Borkosky |
First Address | Sebring, FL 33870-7928 |
Second Address | Sebring, FL 33870-7928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 18/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
59655 | (02) | FL |