Mangrove Wellness Center,Inc

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH12785 Issued in FL

Legal business name

MANGROVE WELLNESS CENTER,INC

Practice address

1515 Tamiami Trail S.
Suite 2
Venice, FL 34285

Phone

(941) 822-5620

Fax

(855) 239-0365

NPI assigned

Oct 24, 2012

Last updated

Oct 13, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lisa Reidsema, LMHC

Title

President

Phone

(941) 822-5620

Specialties & licenses 4

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413158400000",
    "number": "1285987453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 TAMIAMI TRAIL S.",
            "address_2": "SUITE 2",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "34285",
            "telephone_number": "941-822-5620",
            "fax_number": "855-239-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 TAMIAMI TRAIL S.",
            "address_2": "SUITE 2",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "34285",
            "telephone_number": "941-822-5620",
            "fax_number": "855-239-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANGROVE WELLNESS CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-24",
        "last_updated": "2014-10-13",
        "status": "A",
        "authorized_official_last_name": "REIDSEMA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "941-822-5620",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH12785",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "PY5867",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "FL",
            "license": "MH12785",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY5867",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inger Lorraine Malwin-Dabney, DDS
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• Linda J Mangione-Allison, P.A
• Charles Mangone
• Manor Care of Venice FL LLC (ProMedica Skilled Nursing and Rehabilitation (Venice))
• Jessica Maqueira, COTA
• Eva Marciszonek
• Marie L. Trgovac Counseling, P.a.
• Juan J Marin Gaviria

• Mental Health Counselor in Venice, FL
• Providers in Venice, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.