MEDICARE: DR. KENNETH LLOYD GRILL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY0003910	FL

General Provider Information

NPI Number	:	1093772014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH LLOYD GRILL PH.D.

Provider Business Mailing Address
First Line	:	22282 VISTA LAGO DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4764
Country	:	US
Telephone Number	:	561-488-7771
Fax Number	:	561-477-3634

Provider Business Practice Location Address
First Line	:	1690 S CONGRESS AVE STE 100
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-6327
Country	:	US
Telephone Number	:	561-488-7771
Fax Number	:	561-477-3634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/17/2026

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