Provider Demographics
NPI:1134705270
Name:MESSINA, MICHELE (LSP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MESSINA
Suffix:
Gender:F
Credentials:LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5949 APPROACH RD FL 34238
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5720
Mailing Address - Country:US
Mailing Address - Phone:941-445-2323
Mailing Address - Fax:
Practice Address - Street 1:5949 APPROACH RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5720
Practice Address - Country:US
Practice Address - Phone:941-445-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1511103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool