MEDICARE: EAST COAST DRUG TESTING, 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	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1760829311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST DRUG TESTING, LLC.

Provider Business Mailing Address
First Line	:	159 NORTHAMPTON H
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-1744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	224 DATURA ST
Second Line	:	SUITE 402
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5624
Country	:	US
Telephone Number	:	561-408-3929
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEREN ROESSER
Credential	:
Telephone Number	:	561-408-3929

Provider Enumeration Date	:	05/22/2013
Last Update Date	:	05/22/2013

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