Provider Demographics
NPI:1982817359
Name:KEBRDLE, PAMELA (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:KEBRDLE
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 1:3475 SHERIDAN ST
Mailing Address - Street 2:#308
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3663
Mailing Address - Country:US
Mailing Address - Phone:954-964-3040
Mailing Address - Fax:954-964-2496
Practice Address - Street 1:3475 SHERIDAN ST
Practice Address - Street 2:#308
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3663
Practice Address - Country:US
Practice Address - Phone:954-964-3040
Practice Address - Fax:954-964-2496
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005077103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59781Medicare ID - Type Unspecified