Healthcare Provider Details

I. General information

NPI: 1336958826
Provider Name (Legal Business Name): ELENDEA ROSE DEGAETANO RMFTI, RMHCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W PENNSYLVANIA AVE
DELAND FL
32720-3429
US

IV. Provider business mailing address

724 N BOSTON AVE
DELAND FL
32724-2974
US

V. Phone/Fax

Practice location:
  • Phone: 386-290-6525
  • Fax:
Mailing address:
  • Phone: 386-290-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH26998
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: