=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417842022
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALCHEMY THERAPY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2025
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9450 POINCIANA PL APT 405B
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-4876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-228-3148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9450 POINCIANA PL APT 405B
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33324-4876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-228-3148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTY QUEROL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-228-3148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------