=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548637671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LILYPAD COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2015
-----------------------------------------------------
Last Update Date | 08/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9589 VERONA LAKES BLVD
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33472-2759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-713-8511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9589 VERONA LAKES BLVD
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33472-2759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-713-8511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | LAURIE A SPATARO
-----------------------------------------------------
Credential | M.A., C.A.P.
-----------------------------------------------------
Telephone | 561-713-8511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number | ADC0075712015
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | ADC0075712015
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------