Provider Demographics
NPI:1215456397
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/MANAGING MEMBER
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 CAP SAP CRC
Authorized Official - Phone:561-398-8336
Mailing Address - Street 1:2809 POINSETTIA AVE
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:561-439-9934
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:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 261Q00000X, 261QG0250X, 261QH0100X, 261QM1300X, 261QR0400X, 261QR0405X
FLHCC11045207ZP0105X
FL11045261QI0500X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder