Provider Demographics
NPI:1487695029
Name:KIMMEL, JOEL I (PHD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:I
Last Name:KIMMEL
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 1:5551 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4651
Mailing Address - Country:US
Mailing Address - Phone:954-755-2885
Mailing Address - Fax:
Practice Address - Street 1:5551 N UNIVERSITY DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4651
Practice Address - Country:US
Practice Address - Phone:954-755-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2344103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74322YMedicare ID - Type Unspecified