MEDICARE: FLORIDA COAST COUNSELING LLC

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	103TC1900X	Counseling Psychologist
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1457122038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA COAST COUNSELING LLC

Provider Business Mailing Address
First Line	:	2430 VANDERBILT BEACH RD STE 108
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-2654
Country	:	US
Telephone Number	:	239-427-1833
Fax Number	:

Provider Business Practice Location Address
First Line	:	3443 PINE RIDGE RD STE 101
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-3926
Country	:	US
Telephone Number	:	239-427-1833
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER / PSYCHOLOGIST
Name	:	DR. REBECCA ANDERSON
Credential	:	PHD
Telephone Number	:	413-246-5499

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	09/13/2024

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