Healthcare Provider Details

I. General information

NPI: 1962043372
Provider Name (Legal Business Name): MELISSA M. MARCIANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5444 PARK BLVD N STE 206
PINELLAS PARK FL
33781-3300
US

IV. Provider business mailing address

5444 PARK BLVD N STE 206
PINELLAS PARK FL
33781-3300
US

V. Phone/Fax

Practice location:
  • Phone: 727-564-3667
  • Fax:
Mailing address:
  • Phone: 727-564-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MARCIANO
Title or Position: PROPRIETOR/OWNER
Credential: LMHC
Phone: 727-564-3667