Healthcare Provider Details

I. General information

NPI: 1063977163
Provider Name (Legal Business Name): MADISON ANNE PELUSO PH.D., LMHC, MCAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SWAMP CABBAGE CT
FORT MYERS FL
33901-9333
US

IV. Provider business mailing address

2710 SWAMP CABBAGE CT
FORT MYERS FL
33901-9333
US

V. Phone/Fax

Practice location:
  • Phone: 239-666-4545
  • Fax:
Mailing address:
  • Phone: 239-691-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMCAP.0101101
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH22824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: