| Ellie Mental Health Of Estero | |
|
22904 Lyden Dr Ste 104 Estero FL 33928-7048 | |
| (908) 432-4636 | |
| Not Available |
| Full Name | Ellie Mental Health Of Estero |
|---|---|
| Speciality | Counselor |
| Location | 22904 Lyden Dr Ste 104, Estero, Florida |
| Authorized Official Name and Position | Marcus Silva (MANAGING MEMBER) |
| Authorized Official Contact | 9084324636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health Of Estero 4421 Tamarind Way Naples FL 34119-9685 Ph: (908) 432-4636 | Ellie Mental Health Of Estero 22904 Lyden Dr Ste 104 Estero FL 33928-7048 Ph: (908) 432-4636 |
| NPI Number | 1851029243 |
|---|---|
| Provider Enumeration Date | 08/12/2022 |
| Last Update Date | 01/05/2024 |
| Certification Date | 01/05/2024 |
| Medicare PECOS PAC ID | 6002273216 |
|---|---|
| Medicare Enrollment ID | O20230602001757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851029243 | NPI | - | NPPES |
| Provider Name | Andrea Beatriz De Aguayo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730601048 PECOS PAC ID: 4082014766 Enrollment ID: I20210617000971 |
| Provider Name | Christine Arigo English |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790329373 PECOS PAC ID: 7012368541 Enrollment ID: I20240109004794 |
| Provider Name | Bradley Adair Vattilana |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184276511 PECOS PAC ID: 9133571086 Enrollment ID: I20240117000716 |
| Provider Name | Reid Kirchhoff |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184289811 PECOS PAC ID: 5395198352 Enrollment ID: I20240126000951 |
| Provider Name | Sompa Adhya-taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518027051 PECOS PAC ID: 0345686887 Enrollment ID: I20240307000523 |
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