Provider Demographics
NPI:1942740253
Name:PANICCIA, DENA (LCSW)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:PANICCIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 PRESIDENTIAL CT STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3508
Mailing Address - Country:US
Mailing Address - Phone:239-450-7155
Mailing Address - Fax:
Practice Address - Street 1:6237 PRESIDENTIAL CT STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3508
Practice Address - Country:US
Practice Address - Phone:239-450-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW142171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical