Provider Demographics
NPI:1528799574
Name:LIVING SOUL OF NEW YORK, LLC
Entity type:Organization
Organization Name:LIVING SOUL OF NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGM
Authorized Official - Prefix:
Authorized Official - First Name:WIDLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-536-5888
Mailing Address - Street 1:3175 S CONGRESS AVE STE 204A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2515
Mailing Address - Country:US
Mailing Address - Phone:561-572-6773
Mailing Address - Fax:561-828-9322
Practice Address - Street 1:3175 S CONGRESS AVE STE 204A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2515
Practice Address - Country:US
Practice Address - Phone:561-536-5888
Practice Address - Fax:561-828-9322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty