Healthcare Provider Details

I. General information

NPI: 1124641451
Provider Name (Legal Business Name): DR. HANNAH STROM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13774 PLANTATION RD STE 105
FORT MYERS FL
33912-4461
US

IV. Provider business mailing address

13774 PLANTATION RD STE 105
FORT MYERS FL
33912-4461
US

V. Phone/Fax

Practice location:
  • Phone: 239-533-9860
  • Fax: 239-533-9860
Mailing address:
  • Phone: 239-533-9860
  • Fax: 239-533-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC61059615
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: