Healthcare Provider Details

I. General information

NPI: 1063045169
Provider Name (Legal Business Name): PALM BEACH DRUG TESTING, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
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 STE 3-5
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 Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

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