=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447383963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. EIVINA MUNIUTE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2301 W SAMPLE RD STE 3-4A
-----------------------------------------------------
City | POMPANO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33073-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-263-8876
-----------------------------------------------------
Fax | 954-234-2383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2355 SW 15TH ST #71
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33442-7538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-571-8511
-----------------------------------------------------
Fax | 954-234-2383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------