Healthcare Provider Details

I. General information

NPI: 1558292268
Provider Name (Legal Business Name): AMANDA AVERSA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 KEYSTONE RD STE B3
TARPON SPRINGS FL
34688-7403
US

IV. Provider business mailing address

131 CARLYLE DR
PALM HARBOR FL
34683-1806
US

V. Phone/Fax

Practice location:
  • Phone: 727-275-0282
  • Fax:
Mailing address:
  • Phone: 727-330-2632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: