MEDICARE: DOREEN BERNAGOZZI

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	:	1720808496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOREEN BERNAGOZZI

Provider Business Mailing Address
First Line	:	1074 BARBER ST
Second Line	:
City	:	SEBASTIAN
State	:	FL
Zip	:	32958-5575
Country	:	US
Telephone Number	:	772-571-3956
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 INDIAN RIVER BLVD STE C110
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-7135
Country	:	US
Telephone Number	:	772-888-0212
Fax Number	:

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

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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Directions to “ DOREEN BERNAGOZZI ” Practice Location

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