Provider Demographics
NPI:1063615078
Name:KELLER, SYLVIA L (PH D, LMHC, CAP)
Entity type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:L
Last Name:KELLER
Suffix:
Gender:F
Credentials:PH D, LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VILLAGE SQUARE XING
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4545
Mailing Address - Country:US
Mailing Address - Phone:561-339-3931
Mailing Address - Fax:561-624-6137
Practice Address - Street 1:100 VILLAGE SQUARE XING
Practice Address - Street 2:SUITE 104
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4545
Practice Address - Country:US
Practice Address - Phone:561-339-3931
Practice Address - Fax:561-624-6137
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7290101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)