Active NPI
Jennifer Cellitti
- Professional Counselor
- Fort Myers, FL
National Provider Identifier
1396176087
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PMH1419
- Practice address
- 3763 Evans Ave
Fort Myers, FL 33901-9302 - Phone
- (239) 931-9712
- Fax
- (239) 332-6985
- NPI assigned
- Dec 5, 2013
- Last updated
- Feb 24, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 180008714 | IL | |
| Professional Counselor | 101YP2500X | PMH1419 | FL | Primary |
Addresses
Primary practice location
3763 Evans Ave
Fort Myers, FL 33901-9302
Mailing address
3763 Evans Ave
Fort Myers, FL 33901-9302
Phone (239) 931-9712
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PMH1419 | FL | MD | Professional Counselor |
| 180008714 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487894400000",
"number": "1396176087",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3763 EVANS AVE",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339019302",
"telephone_number": "239-931-9712",
"fax_number": "239-332-6985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3763 EVANS AVE",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339019302",
"telephone_number": "239-931-9712",
"fax_number": "239-332-6985"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CELLITTI",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-05",
"last_updated": "2017-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180008714",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "FL",
"license": "PMH1419",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.