Organization
FLORIDA ATLANTIC UNIVERSITY
Active
Parent organization
FLORIDA ATLANTIC UNIVERSITY
Other names
Memory and Wellness Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
FLORIDA ATLANTIC UNIVERSITY
Authorized official
LOUISA PONTIROLI-KELLY (AUTHORIZED OFFICIAL)
(561) 297-2897
Entity
Organization
Contact information
Practice address
777 GLADES RD, BLDG AZ-79, BOCA RATON, FL 33431-6424
(561) 297-0502
(561) 297-0505
Mailing address
777 GLADES RD BLDG AZ-79, BOCA RATON, FL 33431-6424
(561) 297-0502
(561) 297-0505
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC0700X
Clinical Psychologist
—
—
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/07/2006
Last updated
12/15/2025
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