NPIMap

Organization Active NPI

Coastal Mental Health & Wellness, LLC

  • Clinical Social Worker
  • Lakewood Ranch, FL
National Provider Identifier
1679082978
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
COASTAL MENTAL HEALTH & WELLNESS, LLC
Practice address
11705 Evening Walk Drive
Lakewood Ranch, FL 34211
Phone
(941) 928-9774
NPI assigned
Sep 29, 2017
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Victoria Defalco Charland
Title
Ambr
Phone
(941) 928-9774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X Primary

Addresses

Primary practice location

11705 Evening Walk Drive
Lakewood Ranch, FL 34211

Mailing address

PO Box 728
Nokomis, FL 34274-0728
Phone (941) 423-2728

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180126000678 FL Part B Supplier - Clinic/Group Practice 3971862665 Receives reassigned benefits from 9 practitioners
Practice locations: Nokomis, FL

National Provider Directory

National Provider Directory

Locations

1767 Lakewood Ranch Blvd
Bradenton, FL 34211
Phone (941) 423-2728

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1679082978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 728",
            "city": "NOKOMIS",
            "state": "FL",
            "postal_code": "342740728",
            "telephone_number": "941-423-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11705 EVENING WALK DRIVE",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "34211",
            "telephone_number": "941-928-9774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MENTAL HEALTH & WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-29",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "DEFALCO CHARLAND",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "AMBR",
        "authorized_official_telephone_number": "941-928-9774"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood Ranch, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.