Provider Demographics
NPI:1821257379
Name:MARCANTELLI, MINDY ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:ANN
Last Name:MARCANTELLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 ENTERPRISE COVE AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8370
Mailing Address - Country:US
Mailing Address - Phone:386-801-5276
Mailing Address - Fax:
Practice Address - Street 1:118 1/2 N WOODLAND BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4268
Practice Address - Country:US
Practice Address - Phone:386-801-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist