Provider Demographics
NPI:1881737815
Name:CENTER FOR CHILD DEVELOPMENT
Entity type:Organization
Organization Name:CENTER FOR CHILD DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FIDELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCLOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-968-5419
Mailing Address - Street 1:5267 WOODSTONE CIR S
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5841
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5267 WOODSTONE CIR S
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-5841
Practice Address - Country:US
Practice Address - Phone:561-310-4017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization