MEDICARE: ELIZABETH MARADONA, LMHC, P.A.

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	MH11995	FL

General Provider Information

NPI Number	:	1902235096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH MARADONA, LMHC, P.A.

Provider Business Mailing Address
First Line	:	2734 OAK RIDGE CT
Second Line	:	UNIT 404
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2734 OAK RIDGE CT
Second Line	:	UNIT 404
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9369
Country	:	US
Telephone Number	:	239-938-4428
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ELIZABETH MARADONA
Credential	:	LMHC
Telephone Number	:	239-938-4428

Provider Enumeration Date	:	11/08/2013
Last Update Date	:	11/08/2013

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