| Charlotte Behavioral Health Care Inc | |
|
1700 Education Ave Punta Gorda FL 33950-6222 | |
| (941) 639-8300 | |
| (941) 639-6831 |
| Full Name | Charlotte Behavioral Health Care Inc |
|---|---|
| Speciality | Counselor |
| Location | 1700 Education Ave, Punta Gorda, Florida |
| Authorized Official Name and Position | Ralph Jay Glynn (CEO) |
| Authorized Official Contact | 9416398300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charlotte Behavioral Health Care Inc 1700 Education Ave Punta Gorda FL 33950-6222 Ph: (941) 639-8300 | Charlotte Behavioral Health Care Inc 1700 Education Ave Punta Gorda FL 33950-6222 Ph: (941) 639-8300 |
| NPI Number | 1760460653 |
|---|---|
| Provider Enumeration Date | 01/03/2006 |
| Last Update Date | 05/24/2022 |
| Certification Date | 05/24/2022 |
| Medicare PECOS PAC ID | 4587649918 |
|---|---|
| Medicare Enrollment ID | O20040621001195 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760460653 | NPI | - | NPPES |
| 141305800 | Medicaid | FL | |
| 97564 | Other | FL | BLUE CROSS |
| 060480100 | Medicaid | FL |
| Provider Name | Sally J Fontaine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285962811 PECOS PAC ID: 1850434218 Enrollment ID: I20100208000051 |
| Provider Name | Katina A Matthews Ferrari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124038013 PECOS PAC ID: 4880710243 Enrollment ID: I20100923000476 |
| Provider Name | Mario C Oliva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790824936 PECOS PAC ID: 1658555784 Enrollment ID: I20110413000848 |
| Provider Name | Amanda Wood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194248344 PECOS PAC ID: 4284908690 Enrollment ID: I20170925001051 |
| Provider Name | Susie Holliday |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225552623 PECOS PAC ID: 8820487580 Enrollment ID: I20211118000441 |
| Provider Name | Judith Ann Schaetzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043963689 PECOS PAC ID: 8628442019 Enrollment ID: I20230327001639 |
| Provider Name | Shawn Arkon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821643495 PECOS PAC ID: 1557692985 Enrollment ID: I20230410002164 |
| Provider Name | Emily Jane Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366091118 PECOS PAC ID: 7214394840 Enrollment ID: I20230613001115 |
| Provider Name | Sarah Ann Wright |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962652701 PECOS PAC ID: 7517026263 Enrollment ID: I20230619000333 |
| Provider Name | Amy D Hood |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134466212 PECOS PAC ID: 8729422100 Enrollment ID: I20240214001889 |
| Provider Name | Brandi Leigh Sagers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265121065 PECOS PAC ID: 0143660043 Enrollment ID: I20240425001542 |
| Provider Name | Kelly Lauren Hofmann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184069619 PECOS PAC ID: 2961948146 Enrollment ID: I20240724001304 |
| Provider Name | Reagan Carrington Jefferson |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1871345744 PECOS PAC ID: 7214475847 Enrollment ID: I20240814002735 |
| Provider Name | Kelly Rae Decker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427505189 PECOS PAC ID: 5294273652 Enrollment ID: I20240815003933 |
| Provider Name | Keith R Fendelander |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578982369 PECOS PAC ID: 1557809985 Enrollment ID: I20240816002333 |
| Provider Name | Glenda Ann Steffenhagen |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1023287505 PECOS PAC ID: 0446790422 Enrollment ID: I20240904004623 |
| Provider Name | Zady Garcia-luis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215768510 PECOS PAC ID: 0143760025 Enrollment ID: I20240905003972 |
| Provider Name | Kylie Marie Sumner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1427701671 PECOS PAC ID: 6305377391 Enrollment ID: I20241001003478 |
| Provider Name | Willette Amelia Lewis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154805968 PECOS PAC ID: 7012449515 Enrollment ID: I20241022000152 |
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