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General NPI Number Information
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NPI Number | 1053927889
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 10537 LINGER LN
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City | ORLANDO
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State | FL
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Zip | 32821-8819
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Country | US
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Telephone | 407-483-6459
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Fax |
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Provider Business Mailing Address
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Address Line | 10537 LINGER LN
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City | ORLANDO
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State | FL
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Zip | 32821-8819
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Country | US
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Telephone | 407-483-6459
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MANDY PANTANELLA
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Credential | LSCW
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Telephone | 407-483-6459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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