Healthcare Provider Details

I. General information

NPI: 1790259646
Provider Name (Legal Business Name): MEMOREABLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 TAMIAMI TRL N STE 128
NAPLES FL
34103-4135
US

IV. Provider business mailing address

3201 TAMIAMI TRL N STE 128
NAPLES FL
34103-4135
US

V. Phone/Fax

Practice location:
  • Phone: 800-961-3367
  • Fax: 800-961-3367
Mailing address:
  • Phone: 800-961-3367
  • Fax: 800-961-3367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALINA VITALI
Title or Position: MGR
Credential: MSW, LMHC
Phone: 813-770-3118