Provider Demographics
NPI:1073255840
Name:CARPE DIEM BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:CARPE DIEM BEHAVIORAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORILAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:833-322-3423
Mailing Address - Street 1:150 E PALMETTO PARK RD STE 800
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-2466
Practice Address - Country:US
Practice Address - Phone:833-322-3423
Practice Address - Fax:678-359-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty