Provider Demographics
NPI:1104237791
Name:STARTLIVING.COM PLLC
Entity type:Organization
Organization Name:STARTLIVING.COM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLNICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,CAP,ICADC,ENG
Authorized Official - Phone:561-543-1028
Mailing Address - Street 1:760 US HIGHWAY 1 STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4423
Mailing Address - Country:US
Mailing Address - Phone:561-543-1028
Mailing Address - Fax:561-570-1850
Practice Address - Street 1:760 US HIGHWAY 1 STE 200
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4423
Practice Address - Country:US
Practice Address - Phone:561-543-1028
Practice Address - Fax:561-328-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW11875251S00000X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1104237791OtherNPI