Provider Demographics
NPI:1699318212
Name:VENUGOPAL, SARITHA (RMHC-I)
Entity type:Individual
Prefix:
First Name:SARITHA
Middle Name:
Last Name:VENUGOPAL
Suffix:
Gender:F
Credentials:RMHC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3677 CENTRAL AVE STE I
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8226
Mailing Address - Country:US
Mailing Address - Phone:239-839-3907
Mailing Address - Fax:239-936-0114
Practice Address - Street 1:3677 CENTRAL AVE STE I
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8226
Practice Address - Country:US
Practice Address - Phone:239-839-3907
Practice Address - Fax:239-936-0114
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health