Healthcare Provider Details

I. General information

NPI: 1386421949
Provider Name (Legal Business Name): DANIELLA ELZIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5825 ARGERIAN DR STE 101
WESLEY CHAPEL FL
33545-4140
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-723-2700
  • Fax:
Mailing address:
  • Phone: 239-236-8784
  • Fax: 239-790-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: