Healthcare Provider Details

I. General information

NPI: 1487801833
Provider Name (Legal Business Name): MICHAEL P FERRENTINO ED.D., L.M.H.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12196 COUNTY ROAD 512
FELLSMERE FL
32948-5463
US

IV. Provider business mailing address

1555 INDIAN RIVER BLVD STE B210
VERO BEACH FL
32960-7113
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-8224
  • Fax: 772-252-3245
Mailing address:
  • Phone: 772-257-8224
  • Fax: 772-257-8224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3958
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: