Organization
KEYSTONE BEHAVIORAL PEDIATRICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE FALWELL PH. D. (CLINICAL DIRECTOR)
(904) 373-0748
Entity
Organization
Contact information
Practice address
172 CANAL BLVD, PONTE VEDRA BEACH, FL 32082-3606
(904) 373-0748
(904) 671-7377
Mailing address
172 CANAL BLVD, PONTE VEDRA BEACH, FL 32082-3606
(904) 373-0748
(904) 671-7377
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
05/06/2008
Last updated
05/12/2020
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