Healthcare Provider Details

I. General information

NPI: 1891933149
Provider Name (Legal Business Name): MICHELLE LEE BANCROFT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2009
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOODLETTE RD
NAPLES FL
34102-5840
US

IV. Provider business mailing address

400 GOODLETTE RD
NAPLES FL
34102-5840
US

V. Phone/Fax

Practice location:
  • Phone: 239-299-8088
  • Fax:
Mailing address:
  • Phone: 239-299-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT 2329
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11831
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: