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General NPI Number Information
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NPI Number | 1073626255
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Entity Type | Individual
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Provider Name | THERESE KRASNOVSKY PHD
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Gender | Female
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 600 SANDTREE DRIVE SUITE 202B
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403-1500
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Country | US
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Telephone | 561-346-3731
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Fax |
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Provider Business Mailing Address
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Address Line | 17088 133RD TRAIL NORTH
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City | JUPITER
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State | FL
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Zip | 33478-5222
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Country | US
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Telephone | 561-346-3731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY5489
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY5489
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License Number State | FL
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