| Chrysallis Wellness Center Inc | |
|
11932 Faiway Lakes Fort Myers FL 33913 | |
| (239) 738-0926 | |
| Not Available |
| Full Name | Chrysallis Wellness Center Inc |
|---|---|
| Speciality | Counselor |
| Location | 11932 Faiway Lakes, Fort Myers, Florida |
| Authorized Official Name and Position | Marie Carmelle Boisbel (VICE PRESIDENT) |
| Authorized Official Contact | 2397384307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chrysallis Wellness Center Inc 11932 Faiway Lakes Fort Myers FL 33913 Ph: (239) 738-0926 | Chrysallis Wellness Center Inc 11932 Faiway Lakes Fort Myers FL 33913 Ph: (239) 738-0926 |
| NPI Number | 1386272334 |
|---|---|
| Provider Enumeration Date | 03/27/2020 |
| Last Update Date | 04/07/2020 |
| Certification Date | 04/07/2020 |
| Medicare PECOS PAC ID | 8123443017 |
|---|---|
| Medicare Enrollment ID | O20200810001904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386272334 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Andrew S Ferber |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083838106 PECOS PAC ID: 0941486146 Enrollment ID: I20110524000770 |
| Provider Name | Harvey Harris Shapiro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1578577961 PECOS PAC ID: 8325025877 Enrollment ID: I20171005001159 |
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