MEDICARE: SAGE THERAPY 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1659028702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE THERAPY LLC

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	:	OWNER
Name	:	DEANA DUCKENFIELD
Credential	:	LMHC, LPC, MCAP
Telephone Number	:	386-214-0297

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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Directions to “SAGE THERAPY LLC ” Practice Location

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