Healthcare Provider Details

I. General information

NPI: 1619605706
Provider Name (Legal Business Name): ELLIE MENTAL HEALTH OF NAPLES AT 75 VINEYARDS BLVD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VINEYARDS BLVD STE 201
NAPLES FL
34119-4748
US

IV. Provider business mailing address

75 VINEYARDS BLVD STE 201
NAPLES FL
34119-4748
US

V. Phone/Fax

Practice location:
  • Phone: 908-432-4636
  • Fax:
Mailing address:
  • Phone: 908-432-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARCUS SILVA
Title or Position: MANAGING MEMBER
Credential:
Phone: 908-432-4636