Provider Demographics
NPI:1669071965
Name:HOUSE OF MUSIC PSL, LLC
Entity type:Organization
Organization Name:HOUSE OF MUSIC PSL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE TOLEDO DUARTE ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-361-3520
Mailing Address - Street 1:1973 SW SAVAGE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2791
Mailing Address - Country:US
Mailing Address - Phone:772-807-1363
Mailing Address - Fax:
Practice Address - Street 1:1973 SW SAVAGE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2791
Practice Address - Country:US
Practice Address - Phone:772-807-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty