Healthcare Provider Details

I. General information

NPI: 1962611475
Provider Name (Legal Business Name): PETER GRAVES HEYWOOD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 VILLAGE BLVD SUITE 370
WEST PALM BEACH FL
33409-1904
US

IV. Provider business mailing address

580 VILLAGE BLVD SUITE 370
WEST PALM BEACH FL
33409-1904
US

V. Phone/Fax

Practice location:
  • Phone: 561-712-1119
  • Fax: 561-686-2580
Mailing address:
  • Phone: 561-712-1119
  • Fax: 561-686-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY5724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: