Healthcare Provider Details

I. General information

NPI: 1730510843
Provider Name (Legal Business Name): LYNNE PEARL CAP, ICADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2013
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 19TH PL STE. E-2
VERO BEACH FL
32960-0686
US

IV. Provider business mailing address

1705 19TH PL STE. E-2
VERO BEACH FL
32960-0686
US

V. Phone/Fax

Practice location:
  • Phone: 772-257-5995
  • Fax: 772-257-5962
Mailing address:
  • Phone: 772-257-5995
  • Fax: 772-257-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23385
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number101YA0400X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: