MEDICARE: ELLIE MENTAL HEALTH OF NAPLES AT 75 VINEYARDS BLVD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QR0800X	Recovery Care Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619605706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIE MENTAL HEALTH OF NAPLES AT 75 VINEYARDS BLVD

Provider Business Mailing Address
First Line	:	75 VINEYARDS BLVD STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-4748
Country	:	US
Telephone Number	:	908-432-4636
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 VINEYARDS BLVD STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-4748
Country	:	US
Telephone Number	:	908-432-4636
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. MARCUS SILVA
Credential	:
Telephone Number	:	908-432-4636

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	01/05/2026

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