MEDICARE: VICKI L VANELLA

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
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1306983168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI L VANELLA

Provider Business Mailing Address
First Line	:	6150 METROWEST BLVD STE 103
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	407-730-3837
Fax Number	:	407-730-3869

Provider Business Practice Location Address
First Line	:	6150 METROWEST BLVD STE 103
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	352-374-5600
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	10/21/2016

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Directions to “ VICKI L VANELLA ” Practice Location

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