Provider Demographics
NPI:1033751037
Name:KEYS GATE WELLNESS ASSOCIATES, LLC
Entity Type:Organization
Organization Name:KEYS GATE WELLNESS ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANA SPARBER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:305-409-6679
Mailing Address - Street 1:14213 SW 289TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2989
Mailing Address - Country:US
Mailing Address - Phone:305-409-6679
Mailing Address - Fax:
Practice Address - Street 1:100 NE 15TH ST STE 101D
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4564
Practice Address - Country:US
Practice Address - Phone:833-779-8646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty