Healthcare Provider Details

I. General information

NPI: 1912047077
Provider Name (Legal Business Name): CENTER FOR CHILD DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 GREENWOOD AVE SUITE 204
WEST PALM BEACH FL
33407-2452
US

IV. Provider business mailing address

5325 GREENWOOD AVE SUITE 204
WEST PALM BEACH FL
33407-2452
US

V. Phone/Fax

Practice location:
  • Phone: 561-840-6688
  • Fax: 561-840-6676
Mailing address:
  • Phone: 561-840-6688
  • Fax: 561-840-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE WASSERMAN
Title or Position: CEO
Credential: PHD
Phone: 561-882-6434