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General NPI Number Information
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NPI Number | 1134656788
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Entity Type | Organization
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Legal Business Name | NAPLES OCEANSIDE WELLNESS, LLC
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4933 TAMIAMI TRL N STE 200
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City | NAPLES
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State | FL
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Zip | 34103-3028
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Country | US
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Telephone | 239-315-0084
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Fax | 239-236-0905
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Provider Business Mailing Address
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Address Line | 4933 TAMIAMI TRL N STE 200
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City | NAPLES
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State | FL
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Zip | 34103-3028
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Country | US
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Telephone | 239-315-0084
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Fax | 239-236-0905
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | JANESSA MARIE RAMOS
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Credential | LCSW
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Telephone | 239-315-0084
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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 | SW13574
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License Number State | FL
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