NPIMap

Organization Active NPI

Keystone Behavioral Pediatrics, LLC

  • Psychologist
  • Ponte Vedra Beach, FL
National Provider Identifier
1831365154
Registry record updated May 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
KEYSTONE BEHAVIORAL PEDIATRICS, LLC
Practice address
172 Canal Blvd
Ponte Vedra Beach, FL 32082-3606
Phone
(904) 373-0748
Fax
(904) 671-7377
NPI assigned
May 6, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2020

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

Authorized official

Name
Katherine Falwell, PH. D.
Title
Clinical Director
Phone
(904) 373-0748

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

172 Canal Blvd
Ponte Vedra Beach, FL 32082-3606

Mailing address

172 Canal Blvd
Ponte Vedra Beach, FL 32082-3606
Phone (904) 373-0748

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589241600000",
    "number": "1831365154",
    "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": "904-373-0748",
            "fax_number": "904-671-7377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 CANAL BLVD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823606",
            "telephone_number": "904-373-0748",
            "fax_number": "904-671-7377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE BEHAVIORAL PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-06",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A",
        "authorized_official_last_name": "FALWELL",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "904-373-0748",
        "authorized_official_credential": "PH. D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; 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.