Provider Demographics
NPI:1831494103
Name:MEZZIO, GLENDON (GIGI) N (MS)
Entity Type:Individual
Prefix:MS
First Name:GLENDON (GIGI)
Middle Name:N
Last Name:MEZZIO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 ANCHORAGE ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-3843
Mailing Address - Country:US
Mailing Address - Phone:239-463-5005
Mailing Address - Fax:239-463-5005
Practice Address - Street 1:2180 MARAVILLA LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7221
Practice Address - Country:US
Practice Address - Phone:239-332-8009
Practice Address - Fax:239-332-4977
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health