Keystone Behavioral Pediatrics, LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

KEYSTONE BEHAVIORAL PEDIATRICS, LLC

Practice address

185 Landrum LN Ste 100
Ponte Vedra Beach, FL 32082-3824

Phone

(904) 373-0082

Fax

(904) 671-7377

NPI assigned

Feb 24, 2022

Organization subpart

No

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

Authorized official

Name

Matthew Delaney, BCBA

Title

Chief Clinical Officer

Phone

(904) 373-0082

Specialties & licenses 4

Addresses

Tax ID family

Keystone Behavioral Pediatrics LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Keystone Behavioral Pediatrics, LLC

  • Psychologist
  • Ponte Vedra Beach, FL
  • NPI 1831365154
  NPD tax ID
• Keystone Behavioral Pediatrics, LLC

  • Psychologist
  • Ponte Vedra Beach, FL
  • NPI 1962158386
  NPD tax ID

Locations

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

{
    "created_epoch": "1645660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1083360408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 CANAL BLVD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823606",
            "telephone_number": "904-373-0082",
            "fax_number": "904-671-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 LANDRUM LN STE 100",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823824",
            "telephone_number": "904-373-0082",
            "fax_number": "904-671-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE BEHAVIORAL PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-24",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-11",
        "status": "A",
        "authorized_official_last_name": "DELANEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "904-373-0082",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Elizabeth Kelly, ARNP
• Stephanie Kenton, LMHC
• Kimberly Kernohan, RDH
• Deborah Renee Kersey, D.C.
• Daniel Kessler
• Keystone Behavioral Pediatrics, LLC
• Keystone Behavioral Pediatrics, LLC
• Dina Khentigan, DNP, RN, C-EFM, ACE-
• Amanda Khoury
• Andrew Brown King, PHD

• Psychologist in Ponte Vedra Beach, FL
• Providers in Ponte Vedra Beach, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.