Provider Demographics
NPI:1558601757
Name:JANIE THOMAS KONDELL, PSY.D., P.A.
Entity Type:Organization
Organization Name:JANIE THOMAS KONDELL, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KONDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-962-0454
Mailing Address - Street 1:3325 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6999
Mailing Address - Country:US
Mailing Address - Phone:954-962-0454
Mailing Address - Fax:954-962-0989
Practice Address - Street 1:3325 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6999
Practice Address - Country:US
Practice Address - Phone:954-962-0454
Practice Address - Fax:954-962-0989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5414103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1770640427OtherINDIVIDUAL PRACTITIONER
FL177064427OtherINDIVIDUAL PRACTITIONER