Provider Demographics
NPI:1992175129
Name:SEOANE, ELISA
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:SEOANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GOODLETTE-FRANK RD N STE C206
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5666
Mailing Address - Country:US
Mailing Address - Phone:239-289-9796
Mailing Address - Fax:
Practice Address - Street 1:501 GOODLETTE-FRANK RD N STE C206
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5666
Practice Address - Country:US
Practice Address - Phone:239-289-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14019101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health