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General NPI Number Information
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NPI Number | 1790496750
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Entity Type | Organization
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Legal Business Name | MANGROVE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 1226 N TAMIAMI TRL STE 301
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City | SARASOTA
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State | FL
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Zip | 34236-2461
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Country | US
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Telephone | 941-202-0215
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Fax |
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Provider Business Mailing Address
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Address Line | 15 PARADISE PLZ UNIT 251
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City | SARASOTA
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State | FL
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Zip | 34239-6905
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Country | US
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Telephone | 941-202-0215
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | RACHEL FILSON
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Credential | LCSW
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Telephone | 941-356-3898
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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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