MEDICARE: MRS. PENNY BONITA DELERME L.M.H.C.

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	MH6651	FL

General Provider Information

NPI Number	:	1245550680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PENNY BONITA DELERME L.M.H.C.

Provider Business Mailing Address
First Line	:	121 S ORANGE AVE
Second Line	:	SUITE 1500
City	:	ORLANDO
State	:	FL
Zip	:	32801-3221
Country	:	US
Telephone Number	:	407-733-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 S ORANGE AVE
Second Line	:	SUITE 1500
City	:	ORLANDO
State	:	FL
Zip	:	32801-3221
Country	:	US
Telephone Number	:	407-733-2215
Fax Number	:

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/20/2012

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