Provider Demographics
NPI:1669700167
Name:THE CENTER FOR PEDIATRIC NEUROPSYCHOLOGY, LLC
Entity type:Organization
Organization Name:THE CENTER FOR PEDIATRIC NEUROPSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEUROPSYCHOLOGIST/PRESIDE
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KELDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:561-688-9795
Mailing Address - Street 1:500 VILLAGE SQUARE XING
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4548
Mailing Address - Country:US
Mailing Address - Phone:561-688-9795
Mailing Address - Fax:561-688-9796
Practice Address - Street 1:500 VILLAGE SQUARE XING
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4548
Practice Address - Country:US
Practice Address - Phone:561-688-9795
Practice Address - Fax:561-688-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7965103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty