Healthcare Provider Details

I. General information

NPI: 1861063836
Provider Name (Legal Business Name): MARIA CUESTA-REPICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12811 KENWOOD LN STE 213
FORT MYERS FL
33907-5648
US

IV. Provider business mailing address

701 RETREAT DR
NAPLES FL
34110-7942
US

V. Phone/Fax

Practice location:
  • Phone: 239-537-9646
  • Fax:
Mailing address:
  • Phone: 239-405-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: