Healthcare Provider Details

I. General information

NPI: 1700741006
Provider Name (Legal Business Name): M & A PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 SW FOUNTAINVIEW BLVD STE 100
PORT ST LUCIE FL
34986-4528
US

IV. Provider business mailing address

1860 SW FOUNTAINVIEW BLVD STE 100
PORT ST LUCIE FL
34986-4528
US

V. Phone/Fax

Practice location:
  • Phone: 561-365-8436
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ATTANASIO
Title or Position: PRESIDENT
Credential: LMHC
Phone: 561-365-8436