MEDICARE: LICETTE VANESSA SANGIOVANNI LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH20316	FL

General Provider Information

NPI Number	:	1558138503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LICETTE VANESSA SANGIOVANNI LMHC

Provider Business Mailing Address
First Line	:	949 SEABRIGHT AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1215
Country	:	US
Telephone Number	:	561-601-3140
Fax Number	:

Provider Business Practice Location Address
First Line	:	949 SEABRIGHT AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33413-1215
Country	:	US
Telephone Number	:	561-601-3140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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