Healthcare Provider Details

I. General information

NPI: 1518477587
Provider Name (Legal Business Name): SERENITY COUNSELING LCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 58TH DR E STE 104
BRADENTON FL
34202-9086
US

IV. Provider business mailing address

PO BOX 110201
LAKEWOOD RCH FL
34211-0003
US

V. Phone/Fax

Practice location:
  • Phone: 704-458-3025
  • Fax:
Mailing address:
  • Phone: 704-458-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. FRANCES PIA BERTOLINI
Title or Position: OWNER/PRESIDENT
Credential: LCSW
Phone: 704-458-3025