Healthcare Provider Details

I. General information

NPI: 1215118294
Provider Name (Legal Business Name): WALTER TRENSCHEL, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 N OCEAN BLVD LEXINGTON 101
OCEAN RIDGE FL
33435-7086
US

IV. Provider business mailing address

5505 N OCEAN BLVD LEXINGTON 101
OCEAN RIDGE FL
33435-7086
US

V. Phone/Fax

Practice location:
  • Phone: 561-706-3426
  • Fax:
Mailing address:
  • Phone: 561-706-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY4569
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY4569
License Number StateFL

VIII. Authorized Official

Name: ELISE DILEONARDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 954-321-1980