Provider Demographics
NPI:1528562626
Name:IANNOTTI, PENNY ELAINE (RMHCI)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:ELAINE
Last Name:IANNOTTI
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 SANDY MARSH LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5956
Mailing Address - Country:US
Mailing Address - Phone:813-299-3215
Mailing Address - Fax:
Practice Address - Street 1:10208 SANDY MARSH LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5956
Practice Address - Country:US
Practice Address - Phone:813-299-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH16348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health