Healthcare Provider Details

I. General information

NPI: 1992179634
Provider Name (Legal Business Name): GARDNER SOLAR PSYCHOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1499 W PALMETTO PARK RD STE 172
BOCA RATON FL
33486-3328
US

IV. Provider business mailing address

222 YAMATO RD STE 106-333
BOCA RATON FL
33431-4704
US

V. Phone/Fax

Practice location:
  • Phone: 561-414-1650
  • Fax: 561-423-7961
Mailing address:
  • Phone: 561-414-1650
  • Fax: 561-423-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5116
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY5116
License Number StateFL

VIII. Authorized Official

Name: LEORA JOSEPHA GARDNER-SCHAUDER
Title or Position: OWNER
Credential: PH.D
Phone: 561-414-1650