Wilhelmina Siny Koedam, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0003507 Issued in FL

Practice address

134 S Dixie Hwy Ste 104
Hallandale Beach, FL 33009-5423

Phone

(954) 895-4248

Fax

(954) 921-5200

NPI assigned

Sep 2, 2006

Last updated

Mar 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wilhelmina S. Koedam PHD P.a.

  • Clinical Psychologist
  • Hallandale Beach, FL
  • NPI 1851698328
  Medicare reassignment NPD Authorized official
• Stephen W. Koncsol P.a.

  • Clinical Psychologist
  • North Miami Beach, FL
  • NPI 1174820534
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1023110863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 HOLLYWOOD BLVD",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330191607",
            "telephone_number": "954-895-4248",
            "fax_number": "954-921-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 S DIXIE HWY STE 104",
            "city": "HALLANDALE BEACH",
            "state": "FL",
            "postal_code": "330095423",
            "telephone_number": "954-895-4248",
            "fax_number": "954-921-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOEDAM",
        "first_name": "WILHELMINA",
        "middle_name": "SINY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0003507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "650030104",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Szilvia Kocza
• Stephen Wayne Koncsol, PH.D.
• Michal Koren
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• Selin Kurlandski, BSC, MSC, PH.D.

• Clinical Psychologist in Hallandale Beach, FL
• Providers in Hallandale Beach, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.