MEDICARE: IRMA VICTORIA PARAJON

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	MH21576	FL

General Provider Information

NPI Number	:	1811697949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRMA VICTORIA PARAJON

Provider Business Mailing Address
First Line	:	12381 S CLEVELAND AVE STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12381 S CLEVELAND AVE STE 401
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3853
Country	:	US
Telephone Number	:	239-900-6001
Fax Number	:

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

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/14/2023

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Directions to “ IRMA VICTORIA PARAJON ” Practice Location

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