Provider Demographics
NPI:1992179634
Name:GARDNER SOLAR PSYCHOLOGY CENTER
Entity Type:Organization
Organization Name:GARDNER SOLAR PSYCHOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEORA
Authorized Official - Middle Name:JOSEPHA
Authorized Official - Last Name:GARDNER-SCHAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-414-1650
Mailing Address - Street 1:222 YAMATO RD
Mailing Address - Street 2:STE 106-333
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4704
Mailing Address - Country:US
Mailing Address - Phone:561-414-1650
Mailing Address - Fax:561-423-7961
Practice Address - Street 1:1499 W PALMETTO PARK RD
Practice Address - Street 2:STE 172
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3328
Practice Address - Country:US
Practice Address - Phone:561-414-1650
Practice Address - Fax:561-423-7961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5116103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty