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General NPI Number Information
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NPI Number | 1730546862
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Entity Type | Organization
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Legal Business Name | DOMUS LEONUM LLC
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Dates
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Enumeration Date | 01/20/2016
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Last Update Date | 01/20/2016
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Provider Practice Location Address
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Address Line | 1551 FORUM PLACE BUILDING 400 SUITE D/E
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5505
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Country | US
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Telephone | 917-528-0694
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Fax |
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Provider Business Mailing Address
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Address Line | 1551 FORUM PLACE BUILDING 400 SUITE D/E
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-5505
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Country | US
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Telephone | 917-528-0694
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARPANA SHIVDASANI
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Credential | P.A
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Telephone | 917-528-0694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ME49592
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License Number State | FL
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