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General NPI Number Information
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NPI Number | 1477805885
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Entity Type | Organization
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Legal Business Name | AXIOM HEALTH, LLC
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 221 GREENWICH CIR 111
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City | JUPITER
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State | FL
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Zip | 33458-2890
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Country | US
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Telephone | 561-262-6048
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Fax |
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Provider Business Mailing Address
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Address Line | 531 W KALMIA DR 11
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City | LAKE PARK
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State | FL
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Zip | 33403-2272
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Country | US
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Telephone | 561-262-6048
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SAVIANNE MAHARAJ
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Credential | PSYD
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Telephone | 561-262-6048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY8634
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License Number State | FL
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