Active NPI
Justin Michael Puder, PHD
- Counseling Psychologist
- Boca Raton, FL
National Provider Identifier
1154892966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- PY10018
- Practice address
- 1 W Camino Real Ste 201
Boca Raton, FL 33432-5966 - NPI assigned
- Dec 6, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PY10018 | FL | Primary |
Addresses
Primary practice location
1 W Camino Real Ste 201
Boca Raton, FL 33432-5966
Mailing address
8639 Eagle Run Dr Apt 11
Boca Raton, FL 33434-5439
Phone (330) 620-8352
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY10018 | FL | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544054400000",
"number": "1154892966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8639 EAGLE RUN DR APT 11",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334345439",
"telephone_number": "330-620-8352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 W CAMINO REAL STE 201",
"city": "BOCA RATON",
"state": "FL",
"postal_code": "334325966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PUDER",
"first_name": "JUSTIN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-06",
"last_updated": "2018-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "FL",
"license": "PY10018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boca Raton, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.