Healthcare Provider Details

I. General information

NPI: 1427987742
Provider Name (Legal Business Name): MAISON DE LA PROVIDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5039 VENTURA DR
DELRAY BEACH FL
33484-8381
US

IV. Provider business mailing address

5039 VENTURA DR
DELRAY BEACH FL
33484-8381
US

V. Phone/Fax

Practice location:
  • Phone: 786-955-5519
  • Fax:
Mailing address:
  • Phone: 786-955-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MURIELLE BERLUS
Title or Position: CEO
Credential:
Phone: 786-955-5519