MEDICARE: IDA GISELLA SEMORILE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255131421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDA GISELLA SEMORILE

Provider Business Mailing Address
First Line	:	111 ALPINE DR SE
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-6126
Country	:	US
Telephone Number	:	773-209-9807
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 ALPINE DR SE
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-6126
Country	:	US
Telephone Number	:	773-209-9807
Fax Number	:

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

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	11/05/2025

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Directions to “ IDA GISELLA SEMORILE ” Practice Location

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