1467577916 NPI number — MRS. CHRISTY M BOCCABELLA L.M.H.C.

Table of content: MRS. CHRISTY M BOCCABELLA L.M.H.C. (NPI 1467577916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467577916 NPI number — MRS. CHRISTY M BOCCABELLA L.M.H.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOCCABELLA
Provider First Name:
CHRISTY
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.M.H.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOCCABELLA
Provider Other First Name:
CHRISTY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.H.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467577916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7135 COLUMBIA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-2235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-798-4564
Provider Business Mailing Address Fax Number:
727-584-4937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 SEMINOLE BLVD
Provider Second Line Business Practice Location Address:
B-112
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-8124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-518-7294
Provider Business Practice Location Address Fax Number:
727-584-4937
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH5438 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 59-1851170 . This is a "GROUP PRACTICE NO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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