Individual provider Active NPI

Charlie Fisette, LMFT

  • Marriage & Family Therapist
  • Clermont, FL
National Provider Identifier
1619759362
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MT4758 Issued in FL
Practice address
17011 State Road 50 Ste 301
Clermont, FL 34711-8203
Phone
(833) 769-3524
Fax
(352) 432-0106
NPI assigned
Oct 17, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MT4758 FL Primary

Addresses

Primary practice location

17011 State Road 50 Ste 301
Clermont, FL 34711-8203

Mailing address

17011 State Road 50 Ste 301
Clermont, FL 34711-8203
Phone (833) 769-3524

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250417000108 FL Practitioner - Marriage and Family Therapist 9436674926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Personal Recovery Network LLCGroup PAC ID 5092611384, 612 clinicians

Practice addresses (Care Compare)

17011 State Rd
50 Suite 301
Clermont, FL 34711-8203
Phone (352) 833-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MT4758FLMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Personal Recovery Network LLC CurrentSince May 12, 2025 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

17011 State Road 50
Ste 301
Clermont, FL 34711
Phone (352) 833-6300

8570 Granite Ct
Ste 101
Fort Myers, FL 33908
Phone (239) 310-4646

260 Lookout Pl
Ste 202
Maitland, FL 32751
Phone (407) 537-9450

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1697500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767571200000",
    "number": "1619759362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17011 STATE ROAD 50 STE 301",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118203",
            "telephone_number": "833-769-3524",
            "fax_number": "352-432-0106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17011 STATE ROAD 50 STE 301",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347118203",
            "telephone_number": "833-769-3524",
            "fax_number": "352-432-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISETTE",
        "first_name": "CHARLIE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-17",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT4758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clermont, FL

Sources for this page

Verify at the official NPI Registry.