Provider Demographics
NPI:1487831897
Name:LEVEILLE, PRINCESSE
Entity Type:Individual
Prefix:MRS
First Name:PRINCESSE
Middle Name:
Last Name:LEVEILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8067 VIALE MATERA
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5235
Mailing Address - Country:US
Mailing Address - Phone:561-433-6402
Mailing Address - Fax:
Practice Address - Street 1:8067 VIALE MATERA
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-5235
Practice Address - Country:US
Practice Address - Phone:561-433-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFM002320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities