MEDICARE: DENA PANICCIA LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1841093960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENA PANICCIA LLC

Provider Business Mailing Address
First Line	:	1113 NW 12TH LN
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-6091
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 PRESIDENTIAL CT STE 110
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3568
Country	:	US
Telephone Number	:	239-450-7155
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DENA PANICCIA
Credential	:
Telephone Number	:	239-450-7155

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/03/2025

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Directions to “DENA PANICCIA LLC ” Practice Location

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