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General NPI Number Information
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NPI Number | 1497649032
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Entity Type | Organization
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Legal Business Name | THE GOLDEN AGE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1490 NE PINE ISLAND RD BLDG 6
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City | CAPE CORAL
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State | FL
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Zip | 33909-2135
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Country | US
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Telephone | 239-203-1248
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Fax | 239-510-2292
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Provider Business Mailing Address
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Address Line | 1490 NE PINE ISLAND RD BLDG 6
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City | CAPE CORAL
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State | FL
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Zip | 33909-2135
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Country | US
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Telephone | 239-203-1248
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Fax | 239-510-2292
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Authorized Official
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Title or Position | OWNER
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Name | ROSSANA CEPERO
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Credential |
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Telephone | 239-203-1248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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