Healthcare Provider Details

I. General information

NPI: 1962246603
Provider Name (Legal Business Name): SAMANTHA ANN DE FELICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 GREENWOOD AVE STE 105
WEST PALM BEACH FL
33407-2400
US

IV. Provider business mailing address

8895 N MILITARY TRL STE 300C
WEST PALM BEACH FL
33410-6279
US

V. Phone/Fax

Practice location:
  • Phone: 561-244-9499
  • Fax: 561-345-3800
Mailing address:
  • Phone: 561-244-9499
  • Fax: 561-345-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW24218
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW24218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: