MEDICARE: MR. BRIAN J TRELA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW3733	FL

General Provider Information

NPI Number	:	1245272871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN J TRELA LCSW

Provider Business Mailing Address
First Line	:	4335 AEGEAN DR APT 246A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2422
Country	:	US
Telephone Number	:	904-814-9271
Fax Number	:

Provider Business Practice Location Address
First Line	:	4335 AEGEAN DR APT 246A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-2422
Country	:	US
Telephone Number	:	904-814-9271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	05/11/2020

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