MEDICARE: DR. JOYCE HELENA ROSE PSYD

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	079	FL

General Provider Information

NPI Number	:	1912215997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOYCE HELENA ROSE PSYD

Provider Business Mailing Address
First Line	:	1402 TERRY AVE
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33980-2259
Country	:	US
Telephone Number	:	941-624-0366
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 TERRY AVE
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33980-2259
Country	:	US
Telephone Number	:	941-624-0366
Fax Number	:

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

Provider Enumeration Date	:	09/23/2010
Last Update Date	:	09/23/2010

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