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NPI Code Detail

MEDICARE: MR. DAVID L MORTELLARO LPC, LMFT

MEDICARE: MR. DAVID L MORTELLARO LPC, LMFT
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
1101YM0800XMental Health Counselor0701001496VA
2106H00000XMarriage & Family Therapist0717000603VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1005400431OTHERVAVIRGINIA PREMIER (HMO)
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3297608000OTHERVAMAGELLAN
4087620OTHERVASOUTHERN HEALTH/SENTARA
5JOHN DEEREOTHERVAVA0101
6018061OTHERVAVALUE OPTIONS
7132303OTHERVAMANAGED HEALTH NETWORK
8349980OTHERVAMAMSI
9285978OTHERVAANTHEM BCBS
105675123OTHERVAAETNA
1169554OTHERVACIGNA BEHAVIORAL HEALTH

General Provider Information

NPI Number : 1851375836
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID L MORTELLARO LPC, LMFT
Provider Business Mailing Address
First Line : 6980 HIGHFIELDS FARM CIR
Second Line :
City : ROANOKE
State : VA
Zip : 24018-5631
Country : US
Telephone Number : 540-774-4114
Fax Number : 540-772-8242
Provider Business Practice Location Address
First Line : 4656 BRAMBLETON AVE
Second Line :
City : ROANOKE
State : VA
Zip : 24018-3437
Country : US
Telephone Number : 540-772-8043
Fax Number : 540-772-8242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2005
Last Update Date : 10/02/2008

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