Provider Demographics
NPI:1174810543
Name:BLANCA PALENCIA-KERR, PH.D., P.A.
Entity type:Organization
Organization Name:BLANCA PALENCIA-KERR, PH.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALENCIA-KERR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-709-2701
Mailing Address - Street 1:10400 GRIFFIN RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3337
Mailing Address - Country:US
Mailing Address - Phone:954-709-2701
Mailing Address - Fax:
Practice Address - Street 1:10400 GRIFFIN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3337
Practice Address - Country:US
Practice Address - Phone:954-709-2701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty