Healthcare Provider Details

I. General information

NPI: 1780310508
Provider Name (Legal Business Name): MENTAL ALIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9112 ALTERNATE A1A STE 102
PALM BEACH GARDENS FL
33403-1451
US

IV. Provider business mailing address

9112 ALTERNATE A1A STE 102
PALM BEACH GARDENS FL
33403-1451
US

V. Phone/Fax

Practice location:
  • Phone: 561-448-2094
  • Fax:
Mailing address:
  • Phone: 561-448-2094
  • 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: MARGUERITE JOSEPH
Title or Position: PMHNP-BC
Credential: APRN
Phone: 561-448-2094