Provider Demographics
NPI:1780310508
Name:MENTAL ALIVE, LLC
Entity type:Organization
Organization Name:MENTAL ALIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:561-614-8731
Mailing Address - Street 1:500 S AUSTRALIAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6237
Mailing Address - Country:US
Mailing Address - Phone:561-614-8731
Mailing Address - Fax:
Practice Address - Street 1:13932 85TH RD N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33412-2669
Practice Address - Country:US
Practice Address - Phone:561-614-8731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty