Provider Demographics
NPI:1225089246
Name:KERZHNERMAN, IRINA (PHD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KERZHNERMAN
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 1:2200 NW CORPORATE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7307
Mailing Address - Country:US
Mailing Address - Phone:561-203-3823
Mailing Address - Fax:
Practice Address - Street 1:2200 NW CORPORATE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7307
Practice Address - Country:US
Practice Address - Phone:561-203-3823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSY6941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5192AMedicare ID - Type Unspecified