Healthcare Provider Details

I. General information

NPI: 1003317736
Provider Name (Legal Business Name): JOHN JOSEPH CIOTTI JR. RMHCI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 DELTONA BLVD STE A
DELTONA FL
32725-8016
US

IV. Provider business mailing address

8259 ENCLAVE WAY UNIT 101
SARASOTA FL
34243-6376
US

V. Phone/Fax

Practice location:
  • Phone: 386-259-5413
  • Fax:
Mailing address:
  • Phone: 941-706-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH11789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: