Healthcare Provider Details

I. General information

NPI: 1437669728
Provider Name (Legal Business Name): PALM BEACH DRUG TESTING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 POINSETTIA AVE STE 3-5
WEST PALM BEACH FL
33407-5426
US

IV. Provider business mailing address

2809 POINSETTIA AVE
WEST PALM BEACH FL
33407-5426
US

V. Phone/Fax

Practice location:
  • Phone: 561-469-9934
  • Fax:
Mailing address:
  • Phone: 561-469-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEREN MARIE ROESSER
Title or Position: CEO
Credential: LMHC LPC CAP CRRA
Phone: 561-398-8336