Wilhelmina S. Koedam PHD P.a.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY0003507 Issued in FL

Legal business name

WILHELMINA S. KOEDAM PHD P.A.

Practice address

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

Phone

(954) 895-4248

Fax

(954) 921-5200

NPI assigned

Feb 18, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Wilhelmina S. Koedam, PH.DNPI 1023110863

Title

President/Licensed Psychologist

Phone

(954) 895-4248

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wilhelmina Siny Koedam, PH.D.

  • Clinical Psychologist
  • Hallandale Beach, FL
  • NPI 1023110863
  Medicare reassignment NPD Authorized official
• Stephen Wayne Koncsol, PH.D.

  • Psychologist
  • Hallandale Beach, FL
  • NPI 1780694349
  NPD

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

{
    "created_epoch": "1297987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1851698328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2999 N.E. 191 ST.",
            "address_2": "SUITE 701",
            "city": "AVENTURA",
            "state": "FL",
            "postal_code": "33180",
            "telephone_number": "305-653-0098",
            "fax_number": "305-937-2541"
        },
        {
            "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": {
        "organization_name": "WILHELMINA S. KOEDAM PHD P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "KOEDAM",
        "authorized_official_first_name": "WILHELMINA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT/LICENSED PSYCHOLOGIST",
        "authorized_official_telephone_number": "954-895-4248",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0003507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wellpoint Integrative Care PA
• West Broward Ipa
• West Broward Ipa, L.L.C
• Robert M Whitney II, DC., N. M.D.
• Joel Marc Wilentz, MD
• Kerri Louise Wilks, MD
• Chakila Y Williams
• Dorothy Wilson, OCCUPATIONAL THERAPI
• Morgan Raquel Winokur, PAC
• Womens Consultation LLC

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.