Healthcare Provider Details

I. General information

NPI: 1013853282
Provider Name (Legal Business Name): TANYA SCUCCIMARRA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E SYBELIA AVE STE 150
MAITLAND FL
32751-4773
US

IV. Provider business mailing address

100 E SYBELIA AVE STE 150
MAITLAND FL
32751-4773
US

V. Phone/Fax

Practice location:
  • Phone: 407-986-7442
  • Fax:
Mailing address:
  • Phone: 407-986-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: