Provider Demographics
NPI:1265641476
Name:PANIPUCCI, MARTHA REGINA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:REGINA
Last Name:PANIPUCCI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19707 TURNBERRY WAY APT 19E
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2575
Mailing Address - Country:US
Mailing Address - Phone:786-255-4098
Mailing Address - Fax:
Practice Address - Street 1:19707 TURNBERRY WAY APT 19E
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2575
Practice Address - Country:US
Practice Address - Phone:786-255-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH4851OtherLMHC