MEDICARE: DEANA DUCKENFIELD LMHC, MCAP, LPC

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	MH13379	FL

General Provider Information

NPI Number	:	1316297336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANA DUCKENFIELD LMHC, MCAP, LPC

Provider Business Mailing Address
First Line	:	1336 HIGH CT
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5533
Country	:	US
Telephone Number	:	386-214-0297
Fax Number	:

Provider Business Practice Location Address
First Line	:	1336 HIGH CT
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-5533
Country	:	US
Telephone Number	:	386-214-0297
Fax Number	:

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

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	03/12/2023

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