Healthcare Provider Details

I. General information

NPI: 1376878116
Provider Name (Legal Business Name): MARCELLA LISA RUBINO-TILTTI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 INDIAN ROCKS RD 6C
LARGO FL
33774-2000
US

IV. Provider business mailing address

1439 LANDAU ST
HOLIDAY FL
34690-5812
US

V. Phone/Fax

Practice location:
  • Phone: 727-512-3593
  • Fax:
Mailing address:
  • Phone: 727-512-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11191
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT1339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: