Provider Demographics
NPI:1295086965
Name:PALM BEACH DRUG TESTING, LLC.
Entity type:Organization
Organization Name:PALM BEACH DRUG TESTING, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MBR
Authorized Official - Prefix:MS
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROESSER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC CAP SAP CRC
Authorized Official - Phone:561-469-9934
Mailing Address - Street 1:2809 POINSETTIA AVE STE 3-5
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-5426
Mailing Address - Country:US
Mailing Address - Phone:561-439-9934
Mailing Address - Fax:
Practice Address - Street 1:2809 POINSETTIA AVE STE 3-5
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5426
Practice Address - Country:US
Practice Address - Phone:561-439-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X, 133V00000X, 2084A0401X, 101YA0400X, 101YP2500X, 225C00000X, 261Q00000X, 261QH0100X, 261QR0405X, 261QM1300X
FLMH11184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder