Provider Demographics
NPI:1194876474
Name:KATELL, ALAN D (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:KATELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2919
Mailing Address - Country:US
Mailing Address - Phone:954-720-4350
Mailing Address - Fax:954-720-1009
Practice Address - Street 1:7301 N UNIVERSITY DR
Practice Address - Street 2:SUITE 210
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2919
Practice Address - Country:US
Practice Address - Phone:954-720-4350
Practice Address - Fax:954-720-1009
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75514Medicare ID - Type UnspecifiedPSYCHOLOGIST