Healthcare Provider Details

I. General information

NPI: 1245154343
Provider Name (Legal Business Name): DEBRA LYN MAGRONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W EAU GALLIE BLVD STE A
MELBOURNE FL
32935-5385
US

IV. Provider business mailing address

5130 RED BAY LN
GRANT FL
32949-8300
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-7004
  • Fax:
Mailing address:
  • Phone: 860-388-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH28934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: