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General NPI Number Information
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NPI Number | 1639864879
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Entity Type | Individual
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Provider Name | PARVATY JOHANA SOTO DE LEITAO PHD. CHAPLAINCY
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Gender | Female
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 2813 N COURSE DR APT 105A
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City | POMPANO BEACH
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State | FL
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Zip | 33069-3050
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Country | US
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Telephone | 954-650-4226
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Fax |
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Provider Business Mailing Address
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Address Line | 2813 N COURSE DR APT 105A
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City | POMPANO BEACH
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State | FL
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Zip | 33069-3050
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Country | US
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Telephone | 954-650-4226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | FL-23-0022
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 05-20-39-34
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License Number State | PR
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