MEDICARE: DR. DOMINIQUE C LEVEILLE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT3714	FL

General Provider Information

NPI Number	:	1902218977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIQUE C LEVEILLE PHD

Provider Business Mailing Address
First Line	:	15715 S DIXIE HWY STE 325
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-1883
Country	:	US
Telephone Number	:	305-967-3900
Fax Number	:	305-922-3436

Provider Business Practice Location Address
First Line	:	15715 S DIXIE HWY STE 325
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33157-1883
Country	:	US
Telephone Number	:	305-922-3436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	02/15/2022

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