Provider Demographics
NPI:1063002939
Name:KELDO, GEORGETTE JOEDALE
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:JOEDALE
Last Name:KELDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 HAMPTON BLVD APT 510
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5682
Mailing Address - Country:US
Mailing Address - Phone:954-512-8880
Mailing Address - Fax:
Practice Address - Street 1:2717 W CYPRESS CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1756
Practice Address - Country:US
Practice Address - Phone:954-979-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health