Provider Demographics
NPI:1497263594
Name:SCULLY, ERIN MARGUERITE (LMHC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARGUERITE
Last Name:SCULLY
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 1:4300 DUHME RD
Mailing Address - Street 2:
Mailing Address - City:MADEIRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-2892
Mailing Address - Country:US
Mailing Address - Phone:727-391-7001
Mailing Address - Fax:
Practice Address - Street 1:4300 DUHME RD
Practice Address - Street 2:
Practice Address - City:MADEIRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-2892
Practice Address - Country:US
Practice Address - Phone:727-391-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1497263594Medicaid