Healthcare Provider Details

I. General information

NPI: 1730299207
Provider Name (Legal Business Name): CARMEN M BESSELLI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 W MARC KNIGHTON CT
LECANTO FL
34461-6300
US

IV. Provider business mailing address

10880 W GALWAY LN
CRYSTAL RIVER FL
34428-7287
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-6005
  • Fax:
Mailing address:
  • Phone: 352-795-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW000887
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: