Provider Demographics
NPI:1063045169
Name:PALM BEACH DRUG TESTING, LLC.
Entity type:Organization
Organization Name:PALM BEACH DRUG TESTING, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROESSER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC LPC CAP CRRA
Authorized Official - Phone:561-398-8336
Mailing Address - Street 1:2809 POINSETTIA AVE STE 3-5
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-5426
Mailing Address - Country:US
Mailing Address - Phone:561-469-9934
Mailing Address - Fax:
Practice Address - Street 1:2809 POINSETTIA AVE STE 3-5
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5426
Practice Address - Country:US
Practice Address - Phone:561-469-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty