Provider Demographics
NPI:1073626255
Name:KRASNOVSKY, THERESE (PHD)
Entity Type:Individual
Prefix:DR
First Name:THERESE
Middle Name:
Last Name:KRASNOVSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PALM BEACH LAKES BLVD
Mailing Address - Street 2:STE 300F
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6510
Mailing Address - Country:US
Mailing Address - Phone:561-616-3830
Mailing Address - Fax:561-586-3571
Practice Address - Street 1:2001 PALM BEACH LAKES BLVD STE 300F
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6515
Practice Address - Country:US
Practice Address - Phone:561-616-3830
Practice Address - Fax:561-586-3571
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5489103T00000X
FLFLPY5489103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5615862345OtherHOME PHONE #