Healthcare Provider Details

I. General information

NPI: 1669700167
Provider Name (Legal Business Name): THE CENTER FOR PEDIATRIC NEUROPSYCHOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VILLAGE SQUARE XING SUITE 103
PALM BEACH GARDENS FL
33410-4548
US

IV. Provider business mailing address

500 VILLAGE SQUARE XING SUITE 103
PALM BEACH GARDENS FL
33410-4548
US

V. Phone/Fax

Practice location:
  • Phone: 561-688-9795
  • Fax: 561-688-9796
Mailing address:
  • Phone: 561-688-9795
  • Fax: 561-688-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7965
License Number StateFL

VIII. Authorized Official

Name: DR. JILL KELDERMAN
Title or Position: PEDIATRIC NEUROPSYCHOLOGIST/PRESIDE
Credential: PH.D., ABPP
Phone: 561-688-9795