Mariela De Lourdes Fantauzzi

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH16747 Issued in FL

Practice address

255 Evernia St Apt 1516
West Palm Beach, FL 33401-5691

Phone

(787) 908-0032

NPI assigned

Oct 21, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Brave Health Inc.Group PAC ID 8123458981, 112 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Brave Health Inc.

  • Community/Behavioral Health Agency
  • Miami, FL
  • NPI 1821588674

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1287619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552262400000",
    "number": "1689984809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 EVERNIA ST APT 1516",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334015691",
            "telephone_number": "787-908-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 EVERNIA ST APT 1516",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334015691",
            "telephone_number": "787-908-0032"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7 Urb Las Margaritas",
            "address_purpose": "LOCATION",
            "city": "Isabela",
            "state": "PR",
            "postal_code": "006622212",
            "country_code": "US",
            "telephone_number": "787-640-0770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FANTAUZZI",
        "first_name": "MARIELA",
        "middle_name": "DE LOURDES",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-21",
        "last_updated": "2019-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH16747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jade Fang, A.P.
• Keh Nan Fang
• Paige Ellen Fant, LCSW, MCAP, ICADC
• Fantastic Wound Care Inc
• Fantastic Wound Care LLC
• Susan Fante, CRNA
• Bambi D Fanto, M.S.
• Frank Fanto
• Sam Michael Faradyan, M.D.
• Cristina Farah

• Mental Health Counselor in West Palm Beach, FL
• Providers in West Palm Beach, 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 Mar 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.