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General NPI Number Information
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NPI Number | 1033751037
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Entity Type | Organization
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Legal Business Name | KEYS GATE WELLNESS ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/10/2019
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 100 NE 15TH ST STE 101D
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City | HOMESTEAD
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State | FL
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Zip | 33030-4564
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Country | US
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Telephone | 833-779-8646
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Fax |
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Provider Business Mailing Address
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Address Line | 14213 SW 289TH TER
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City | HOMESTEAD
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State | FL
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Zip | 33033-2989
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Country | US
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Telephone | 305-409-6679
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/CLINICAL DIRECTOR
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Name | DR. JACQUELINE SANTANA SPARBER
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Credential | PSY.D.
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Telephone | 305-409-6679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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