Provider Demographics
NPI:1629702436
Name:SAINT-LOUIS, DANIEL MARIE ALICE
Entity Type:Individual
Prefix:MRS
First Name:DANIEL
Middle Name:MARIE ALICE
Last Name:SAINT-LOUIS
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 1:11503 CANOPY LOOP
Mailing Address - Street 2:
Mailing Address - City:MIROMAR LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33913-9457
Mailing Address - Country:US
Mailing Address - Phone:305-917-3169
Mailing Address - Fax:
Practice Address - Street 1:11503 CANOPY LOOP
Practice Address - Street 2:
Practice Address - City:MIROMAR LAKES
Practice Address - State:FL
Practice Address - Zip Code:33913-9457
Practice Address - Country:US
Practice Address - Phone:305-917-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1862420106S00000X
FL1-23-67711103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102945100Medicaid