MEDICARE: THE CENTER FOR PEDIATRIC NEUROPSYCHOLOGY, LLC

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	103G00000X	Clinical Neuropsychologist	PY7965	FL

General Provider Information

NPI Number	:	1669700167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CENTER FOR PEDIATRIC NEUROPSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	500 VILLAGE SQUARE XING
Second Line	:	SUITE 103
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4548
Country	:	US
Telephone Number	:	561-688-9795
Fax Number	:	561-688-9796

Provider Business Practice Location Address
First Line	:	500 VILLAGE SQUARE XING
Second Line	:	SUITE 103
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4548
Country	:	US
Telephone Number	:	561-688-9795
Fax Number	:	561-688-9796

Authorized Official
Title or Position	:	PEDIATRIC NEUROPSYCHOLOGIST/PRESIDE
Name	:	DR. JILL KELDERMAN
Credential	:	PH.D., ABPP
Telephone Number	:	561-688-9795

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	11/29/2012

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