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General NPI Number Information
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NPI Number | 1548097819
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Entity Type | Organization
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Legal Business Name | STACI LEAVITT MIND & BODY INC
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 27 MCGOVERN DR
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City | MELVILLE
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State | NY
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Zip | 11747-4258
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Country | US
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Telephone | 516-433-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 27 MCGOVERN DR
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City | MELVILLE
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State | NY
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Zip | 11747-4258
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Country | US
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Telephone | 516-433-1456
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MISS STACI LEAVITT DAVIDSON
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Credential | RD
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Telephone | 516-433-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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