MEDICARE: MARISSA JANENE MANNETTA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH17360	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003171547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA JANENE MANNETTA LMHC

Provider Business Mailing Address
First Line	:	7635 ASHLEY PARK CT STE 503H
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6197
Country	:	US
Telephone Number	:	407-963-4733
Fax Number	:	407-215-9436

Provider Business Practice Location Address
First Line	:	7635 ASHLEY PARK CT STE 503H
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-6197
Country	:	US
Telephone Number	:	407-963-4733
Fax Number	:	407-215-9436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	08/12/2020

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