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General NPI Number Information
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NPI Number | 1063977163
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Entity Type | Individual
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Provider Name | MADISON ANNE PELUSO PH.D., LMHC, MCAP
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Gender | Female
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2710 SWAMP CABBAGE CT
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City | FORT MYERS
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State | FL
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Zip | 33901-9333
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Country | US
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Telephone | 239-666-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 SWAMP CABBAGE CT
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City | FORT MYERS
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State | FL
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Zip | 33901-9333
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Country | US
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Telephone | 239-691-4975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH22824
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MCAP.0101101
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License Number State | FL
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