Provider Demographics
NPI:1639864879
Name:SOTO DE LEITAO, PARVATY JOHANA (PHD CHAPLAINCY)
Entity Type:Individual
Prefix:
First Name:PARVATY
Middle Name:JOHANA
Last Name:SOTO DE LEITAO
Suffix:
Gender:F
Credentials:PHD CHAPLAINCY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 N COURSE DR APT 105A
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3050
Mailing Address - Country:US
Mailing Address - Phone:954-650-4226
Mailing Address - Fax:
Practice Address - Street 1:2813 N COURSE DR APT 105A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3050
Practice Address - Country:US
Practice Address - Phone:954-650-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL-23-0022101YP1600X
PR05-20-39-34101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)