Provider Demographics
NPI:1063977163
Name:PELUSO, MADISON ANNE (PHD, LMHC, MCAP)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:ANNE
Last Name:PELUSO
Suffix:
Gender:
Credentials:PHD, LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SWAMP CABBAGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9333
Mailing Address - Country:US
Mailing Address - Phone:239-691-4975
Mailing Address - Fax:
Practice Address - Street 1:2710 SWAMP CABBAGE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9333
Practice Address - Country:US
Practice Address - Phone:239-666-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22824101YM0800X
FLMCAP.0101101101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)