Provider Demographics
NPI:1336958826
Name:DEGAETANO, ELENDEA ROSE (RMFTI, RMHCI)
Entity type:Individual
Prefix:MRS
First Name:ELENDEA
Middle Name:ROSE
Last Name:DEGAETANO
Suffix:
Gender:F
Credentials:RMFTI, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 N BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-2974
Mailing Address - Country:US
Mailing Address - Phone:386-290-6525
Mailing Address - Fax:
Practice Address - Street 1:121 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3429
Practice Address - Country:US
Practice Address - Phone:386-290-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT4296106H00000X
FLIMH26998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health