Provider Demographics
NPI:1770640427
Name:KONDELL, JANIE THOMAS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANIE
Middle Name:THOMAS
Last Name:KONDELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3475 SHERIDAN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3663
Mailing Address - Country:US
Mailing Address - Phone:954-962-0454
Mailing Address - Fax:954-962-0989
Practice Address - Street 1:3475 SHERIDAN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3663
Practice Address - Country:US
Practice Address - Phone:954-962-0454
Practice Address - Fax:954-962-0989
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical